中晚期乳腺癌的血供特点及术前DSA造影下超选择性动脉插管灌注化疗栓塞的临床分析  

Clinical Analysis of Preoperative Super-Selective Arterial Catheterization Chemoembolization under DSA for Advanced Breast Cancer and Their Characteristics of Blood Supply Artery

作　　者：周韬[1] 庄亚强[1] 许彪[1] 覃舒婷[1] 

机构地区：[1]广西医科大学第五附属医院乳腺甲状腺外科,广西柳州545006

出　　处：《中国普外基础与临床杂志》2012年第8期850-855,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：广西卫生厅科技计划项目(项目编号:Z2008413)~~

摘　　要：目的总结中晚期乳腺癌的血液供应来源和特点以及探索术前DSA造影下超选择性动脉插管灌注化疗栓塞的方法、疗效及临床应用价值。方法选取我院2007年2月至2011年10月期间经穿刺活检病理证实的中晚期乳腺癌患者共60例,采用Seldinger方法,经股动脉穿刺插管后在DSA造影下明确肿瘤供血动脉分布,然后分别超选择性插管于靶血管内,将吡柔比星60 mg+紫杉醇120 mg二联化疗药物缓慢注入靶血管内,实施介入灌注化疗,最后使用明胶海绵颗粒栓塞肿瘤供血动脉。结果 60例患者经DSA造影共发现112条明确的供血动脉,其中单支供血8例;多支供血52例,主要以胸外侧动脉和(或)胸廓内动脉供血为主。完全缓解率为25.0%(15/60),部分缓解率为73.3%(44/60),稳定率为1.7%(1/60),无进展病例,总有效率为98.3%(59/60)。中位缓解期19个月,中位生存期40个月。结论乳腺癌原发肿瘤的位置与供血动脉密切相关,肿瘤位于乳腺外侧主要由胸外侧动脉主导供血,肿瘤位于乳腺内侧主要由胸廓内动脉主导供血。乳腺癌术前DSA造影下超选择性供血动脉插管、靶血管区域实施灌注化疗和明胶海绵颗粒栓塞,可明显提高乳腺癌新辅助化疗的疗效、远期生存率及介入化疗栓塞治疗的针对性。Objective To summarize the blood supply to the sources and characteristics of advanced breast cancer,and explore the method,efficacy,and clinical applications of preoperative super-selective arterial catheterization chemoembolization under DSA for it.MethodsSixty patients with advanced breast cancer confirmed by the aspiration biopsy from February 2007 to October 2011 in this hospital were selected.Seldinger method was used,distributing of the tumor blood supply artery was identified and intubated the target artery by super-selective arterial catheterization via the femoral artery puncture under the DSA.Then,pirarubicin 60 mg plus paclitaxel 120 mg of two chemotherapy drugs was injected into slowly the target artery and the intervention infusion chemotherapy was performed,finally the tumor blood supply artery was embolizated by gelatin sponge particle.Results A total of 112 conclusive blood supply artery in 60 patients with DSA were found,including eight cases of single blood supply artery,52 cases of multiple blood supply arteries,mainly in the lateral thoracic artery and（or） internal thoracic artery-based.The complete remission rate was 25.0%（15/60）,partial remission rate was 73.3%（44/60）,stable disease rate was 1.7%（1/60）,the total effective rate was 98.3%（59/60）.There was no progression disease.The median remission duration was 19 months,median survival time was 40 months.ConclusionsThe location of the original foci of breast cancer is closely related to blood supply arteries.The tumor in the lateral of the breast mainly dominates by the lateral thoracic artery blood supply.The tumor in the inner breast mainly dominates by the internal thoracic artery blood supply.The preoperative super-selective arterial catheterization chemoembolization under DSA can obviously improve the therapeutic effect,long-term survival,and the target of interventional chemoembolization.

关 键 词：乳腺癌 介入治疗 化疗栓塞 选择性动脉插管 

分 类 号：R655.8[医药卫生—外科学] R737.9[医药卫生—临床医学]