超选择性颅内动脉灌注治疗肺癌脑转移  

Superselective intracranial artery infusion in brain metastasis of lung cancer

作　　者：姜镕[1] 李笑更[1] 

机构地区：[1]天津市环湖医院体介入科,300060

出　　处：《中国现代神经疾病杂志》2005年第5期334-339,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨经皮股动脉穿刺超选择性颅内动脉、支气管动脉插管,区域性动脉内灌注化疗药物治疗肺癌脑转移的临床疗效。方法62例经影像学检查明确诊断的晚期肺癌脑转移患者,采用Seldinger技术行经皮股动脉穿刺(BALT、SIM或TERUMO导管)分别超选择至颈内动脉、椎动脉和支气管动脉进行造影,证实肿瘤供养动脉后分别依次灌注稀释后的联合化疗药(包括鬼臼噻酚甙、嘧啶亚硝脲、卡铂、羟基喜树碱、5-氟脲嘧啶、吡柔比星),1次/月,连续治疗3次为1个疗程。治疗后1个月复查胸部CT、头部MRI,然后根据世界卫生组织的疗效判断标准进行疗效评估。治疗期间每月测定1次血象及肝、肾功能,进行化疗药物的毒副反应监测,必要时予以保护性治疗。结果62例患者动脉内插管均获成功,患者的颅内高压症状于化疗药物灌注后24～48h不同程度减轻。头部MRI及胸部CT检查显示,62例中59例颅内转移瘤不同程度缩小,15例脑肿瘤直径<3cm,脑水肿消失。治愈好转率(完全缓解+部分缓解)为80.65%(50/62)。结论应用颅内动脉灌注化疗药物治疗肺癌脑转移患者的方法操作简单、并发症少,药物可经导管直接进入肿瘤供养动脉,迅速杀死肿瘤细胞,而且全身不良反应(世界卫生组织抗肿瘤药物毒性反应分度标准)低于Ⅱ度。故对不适宜手术治疗的晚期肺癌脑转移患者,颅内动脉区域性化疗药物灌注治疗是有效提高生存质量、延长生存期的首选治疗方法。Objective To study the clinical effect of superselective intracranial and bronchial artery catheterization via percutaneous femoral artery puncture, and local intra-arterial infusion of chemotherapeutic agents in treating brain metastasis of lung cancer. Methods A total of 62 brain metastasis in patients with advance lung cancer received this treatment with Seldinger＇s technique. The therapeutic procedure comprised the percutaneous femoral artery puncture, catheters such as BALT, SIM or TERUMO were superselectively advanced into the intracaroid artery, vertebral artery and bronchial artery respectively. After angiographic confirming these arteris were the tumor＇s nutrient arteries, the diluted combined chemotherapeutic agents including nimustine, teniposide, carboplatin, hydroxycamptothecine, 5-fluorouracil and pirarubicin were infused. The procedure was performed once every month and three months treatment as one course. Checked the chest CT and brain MRI one month later, and elvaluated the treatment effect according to WHO criteria of therapeutic effect. During treatment blood examination was performed every month for monitoring hepatic and renal function to find the toxic and side reaction of chemotherapy. Protective treatment was performed if necessary. Results The superselective intracranial catheterization was achieved successfully in all the 62 patients and the symptoms of intracranial high pressure relieved in 24-28 h after the infusion. The images of brain MRI and chest CT demonstrated that the metastatic tumors of brain were all smaller than pretreatment in 59 out of the 62 patients, the diameter of the brain tumor reduced more than 3 cm and the brain edema disappeared. According to the WHO criteria, the cure rate and improvement rate were over 80.65%（50/62）. Conclusion Intracranial artery infusion is the firstchoice treatment for brain metastasis of advanced lung cancer patients whom are unappropriate for surgery. It can effectively improve patients＂ living quality and prolong their survival

关 键 词：肺肿瘤 输注 动脉内 脑肿瘤 支气管动脉 颈动脉 内 动脉灌注治疗 颅内动脉灌注 肺癌脑转移 超选择性 SELDINGER技术 化疗药物治疗 经皮股动脉穿刺 支气管动脉插管 动脉区域性化疗 

分 类 号：R734.2[医药卫生—肿瘤]