乳腺癌的血液供应及术前动脉灌注化疗  

The blood supply and preoperative intra-arterial chemotherapy of breast cancer

作　　者：周汝明[1] 邱水波[1] 刘闽华[1] 吴育民[1] 杨慧君[1] 庄少育[1] 

机构地区：[1]广东省深圳市第二人民医院放射科,广东深圳518035

出　　处：《中国医学影像技术》2008年第9期1449-1452,共4页Chinese Journal of Medical Imaging Technology

基　　金：深圳市科技计划项目(医疗卫生类)(200703230)

摘　　要：目的探索乳腺癌的血液供应来源和术前动脉灌注化疗的方法及临床价值。方法60例经穿刺细胞学诊断为乳腺癌的患者,经股动脉穿刺插管至患侧锁骨下动脉行数字减影动脉造影,观察乳腺和淋巴结内肿瘤血管、肿瘤染色及其血供来源。根据肿瘤血管多少及来源分别对胸廓内动脉、胸外侧动脉及锁骨下动脉灌注不同剂量的丝裂霉素、表柔比星和5-氟尿嘧啶。结果47例(78.3%)乳腺内见肿瘤血管及肿瘤染色,67支动脉单独或参与乳腺内肿瘤供血,其中胸廓内动脉占56.7%(38/67),胸外侧动脉29.9%(20/67),腋动脉直接乳房支11.9%(8/67),肩胛下动脉1.5%(1/67)。不同肿瘤部位、肿瘤分期和病理类型血供来源无统计学差异。2例纵隔淋巴结为胸廓内动脉供血,35例腋窝淋巴结染色者胸外侧动脉供血占75.6%,肩胛下动脉占24.4%。灌注后4周完全缓解(CR)3例(5%),部分缓解(PR)48例(80%),疾病稳定(SD)9例(15%)。无严重并发症发生。结论胸廓内动脉是乳腺内肿瘤的主要供血动脉,胸外侧动脉是腋窝淋巴结的主要供血动脉。术前动脉灌注化疗可缩小肿瘤体积,降低临床分期,提高保乳手术率。Objective To investigate the blood supply of breast cancer, the method and clinical value of preoperative intra-arterial chemotherapy. Methods DSA of the tumor-sided subclavian artery was performed on 60 cases with breast cancers, which were diagnosed by puncture cytology. Tumorous vascularization and staining in the breast and lymph nodes were observed. Mitomycin, epirubicin and fluorouracil were infused into the internal thoracic arteries, lateral thoracic arteries and subclavian arteries. The doses were decided by quantity and origin of the tumorous vascularization. Results The tumorous vascularization and staining were found in 47 cases （78.3%）. Sixty-seven arteries were proved providing blood for the tumor in breast alone or cooperatively, including internal thoracic arteries （56.7%）, lateral thoracic arteries （29.9%）, mammary branch of axillary arteries （11.9%） and subscapular arteries （1.5%）. The blood supply of the lymph nodes in mediastinum on 2 cases originate from the internal thoracic arteries, and the blood supply of the axillary lymph nodes on 35 cases originate from lateral thoracic arteries （75.6%） and subscapular arteries （24.4%）. CR were observed on 3 cases （5%）, PR on 48 cases （80%） and SD on 9 cases （15%） 4 weeks after intra-arterial infusion. No serious complication was observed. Conclusion Internal thoracic artery is the main blood supply for the tumors in the breast, and lateral thoracic artery is the main blood supply for the axillary lymph nodes. Preoperative intraarterial chemotherapy is significantly effective for volume reducing, downstaging of breast cancer, and increasing the rate of breast conservation surgery.

关 键 词：乳腺癌 血管造影术 新辅助化疗 灌注 动脉内 

分 类 号：R739.7[医药卫生—肿瘤] R814.43[医药卫生—临床医学]