经支气管动脉和非支气管性体动脉栓塞治疗原发性肺癌咯血临床效果  

Clinical efficacy of bronchial arterial embolization together with non-bronchial systemic artery embolization for hemoptysis due to primary lung cancer

作　　者：李奋强[1] 苏东君[1] 李更相 彭玉星 党磊[1] 王文辉[1] LI Fenqiang;SU Dongjun;LI Gengxiang;PENG Yuxing;DANG Lei;WANG Wenhui(Department of Interventional Medicine,First Hospital of Lanzhou University,Lanzhou,Gansu Province 730000,China)

机构地区：[1]兰州大学第一医院介入医学科,730000

出　　处：《介入放射学杂志》2021年第1期52-56,共5页Journal of Interventional Radiology

摘　　要：目的评价经支气管动脉和非支气管性体动脉栓塞(BAE+NBSAE)治疗原发性肺癌所致咯血患者的安全性和有效性,探讨影响BAE+NBSAE术后无咯血时间的相关因素。方法回顾性分析兰州大学第一医院2007年7月至2018年12月采用BAE+NBSAE术治疗的38例原发性肺癌伴咯血患者临床资料。其中非小细胞肺癌30例,小细胞肺癌8例;Ⅳ期肺癌28例。手术开始前21例为大咯血(>300 mL/24 h),10例为中度咯血(<300 mL/24 h),7例为血痰。结果 38例BAE+NBSAE术均获成功。31例(81.6%)取得临床成功。术后患者总平均生存时间为141(103.7~178.3) d,总中位生存期为92(86.0~98.0) d;临床成功、失败患者中位生存期分别为92(52.7~131.3) d、21(13.3~28.7) d;临床成功、失败患者中位无咯血时间分别为87(76.4~97.6) d、10(7.4~12.6) d(P=0.001)。多因素Cox回归分析结果显示,大咯血(P=0.004)、癌性空洞(P=0.001)、肿瘤直径大(P=0.004)为BAE+NBSAE术后缩短无咯血时间独立影响因素。结论 BAE+NBSAE术控制原发性肺癌所致咯血安全有效,但患者死亡率仍很高。大咯血、癌性空洞、肿瘤直径大是BAE+NBSAE术后缩短无咯血时间的重要预测因素。Objective To evaluate the safety and efficacy of bronchial arterial embolization(BAE) together with non-bronchial systemic artery embolization(NBSAE) in treating hemoptysis due to primary lung cancer,and to discuss the factors related to the hemoptysis-free survival time after BAE +NBSAE.Methods The clinical data of 38 patients with primary lung cancer complicated by hemoptysis,who were admitted to the First Hospital of Lanzhou University of China to receive BAE +NBSAE therapy during the period from July 2007 to December 2018,were retrospectively analyzed. Among the 38 patients,non-small cell lung cancer was seen in 30 patients,small cell lung cancer in 8 patients and stage IV lung cancer in 28 patients. Before BAE+NBSAE treatment,21 patients had massive hemoptysis(>300 ml/24 h),10 patients had moderate hemoptysis(<300 ml/24 h) and 7 patients had bloody sputum. Results Successful BAE+NBSAE procedure was accomplished in all 38 patients. Clinical success was achieved in 31 patients(81.6%). The total mean survival time after BAE+NBSAE was 141 days(103.7-178.3 days),the total median survival time was 92 days(86.0-98.0 days). In patients with therapeutic success and in patients with therapeutic failure,the median survival time was 92 days(52.7-131.3 days) and 21 days(13.3-28.7 days) respectively,the hemoptysis-free survival time was 87 days(76.4-97.6 days) and 10 days(7.4-12.6 days) respectively(P=0.001). Multivariate Cox regression analysis indicated that massive hemoptysis(P=0.044),presence of cancerous cavity(P=0.001) and larger tumor diameter(P=0.004) were the independent factors for the reduction of hemoptysis-free time after BAE+NBSAE treatment. Conclusion For controlling hemoptysis in patients with primary lung cancer,BAE+NBSAE is a safe and effective method although the mortality in these patients is still very high. The massive hemoptysis,presence of cancerous cavity and large tumor diameter are important predictors for the reduction of hemoptysisfree time after BAE+NBSAE treatment.(J Intervent Radiol,2021,30

关 键 词：咯血 肺癌 支气管动脉 非支气管性体动脉 介入栓塞 

分 类 号：R734[医药卫生—肿瘤]