纵隔肿瘤血管造影及栓塞的临床应用  

The clinical application of angiography and embolization in treating mediastinal tumors

作　　者：刘玉金[1] 张孝军[1] 宋鹏[2] 王志军[2] 徐家华[1] 王茂强[2] 

机构地区：[1]上海同济大学附属第十人民医院介入放射科,200072 [2]解放军总医院介入放射科

出　　处：《介入放射学杂志》2012年第11期916-920,共5页Journal of Interventional Radiology

摘　　要：目的评价纵隔肿瘤供血动脉来源及其栓塞的价值。方法收集近年来经肿瘤供血动脉栓塞治疗的纵隔肿瘤6例,其中胸骨后甲状腺肿1例,恶性胸腺瘤1例,恶性神经纤维瘤2例,滑膜肉瘤1例,纵隔型肺癌1例,均经手术病理证实。分析纵隔肿瘤的动脉供血来源,评估栓塞对辅助手术切除及预后的价值。结果纵隔肿瘤根据生长位置可有不同的供血动脉,本组病例所见主要供血动脉有甲状颈干、胸廓内动脉、支气管动脉、膈下动脉和肋间动脉,发生胸壁侵犯时可有胸壁外侧动脉供血。肝动脉也可向邻近纵隔肿瘤供血。可同时有纵隔两侧动脉供血。3例于栓塞后20 h内手术切除,术中出血明显较少,肿瘤易于剥离,切除标本可见肿瘤大部分变性坏死。3例因为术后复发、瘤体巨大未行手术切除,复查可见肿瘤大部分坏死、体积萎缩。结论纵隔肿瘤供血动脉来源复杂,需根据肿瘤部位、大小及侵犯范围全面寻找可能的供血动脉,以达到彻底栓塞的目的。栓塞对于辅助手术切除和控制肿瘤发展具有积极作用。Objective To assess the value of angiography in clarifying the origins of the feeding arteries of mediastinal tumors, and to discuss the application of embolization therapy in treating mediastinal tumors. Methods Six patients with mediastinal tumors, who were encountered at authors＇ hospital in recent years, were enrolled in this study. Transcatheter embolization of the tumor-feeding arteries was carried out in all the patients. The lesions included substernal goiter （n = 1）, malignant thymoma （n = 1）, malignant neurofibromas （n = 2）, synovial sarcoma （n = 1） and lung cancer of mediastinal type （n = 1）. All the diagnoses were pathologically proved. The origins of the tumor-feeding arteries were analyzed. The clinical value of embolization in assisting the surgery as well as in making prognosis was assessed. Results According to their location and size, mediastinal tumors could have feeding arteries from different origins. In this series, the tumor-feeding arteries originated from thyrocervical trunk, internal mammary artery, bronchial artery, inferior phrenic artery, intercostal artery and chest wall lateral artery when the chest wall was involved. Hepatic artery could also supply blood to the adjacent mediastinal tumors. The larger tumors could be supplied by the arteries originating from both sides of mediastinum. In three patients the mediastinal tumor was surgically removed within 20 hours after the embolization, and the amount of blood loss during the operation was significantly small. The tumor was peeled off easily. Pathologically, subtotal necrosis of the tumor lesion was seen. Three cases were not able to receive surgical resection because of postoperative recurrence and tremendous tumor size. Follow- up CT and MRI performed within three months after the treatment showed that most part of the tumor became necrotic and the tumor shrank markedly. Conclusion The origins of the feeding arteries in mediastinal tumors are very complex. Every possible tumor- feeding artery that can be roug

关 键 词：纵隔肿瘤 血管造影 栓塞 

分 类 号：R734.5[医药卫生—肿瘤]