上腔静脉支架置入术联合DEB-BACE治疗难治性NSCLC合并上腔静脉综合征11例诊治报告  

Superior vena cava stenting combined with drug-eluting beads transbronchial arterial chemoembolization for treating 11 cases of refractory non-small cell lung cancer complicated with superiorvena

作　　者：邓屹 崔伟[2] 许荣德 孙元亮 陈兢兢 崔景华 叶苏意 陈俞溪 陈泳衡 李静 Deng Yi;Cui Wei;Xu Rongde;Sun Yuanliang;Chen Jingjing;Cui Jinghua;Ye Suyi;Chen Yuxi;Chen Yongheng;Li Jing(Department of Pulmonary and Critical Care Medicine,the Affiliated Hospital of Kunming University of Science and Technology,the First People′s Hospital of Yunnan Province,Kunming 650032,China;Department of Interventional Radiology,Guangdong Provincial People′s Hospital of Southern Medical University(Guangdong Academy of Medical Sciences),Guangzhou 510080,China;Department of Pulmonary and Critical Care Medicine,Guangdong Provincial People′s Hospital of Southern Medical University(Guangdong Academy of Medical Sciences),Guangzhou 510080,China)

机构地区：[1]昆明理工大学附属医院云南省第一人民医院呼吸与危重症医学科,昆明650032 [2]南方医科大学附属广东省人民医院(广东省医学科学院)微创介入科,广州510080 [3]南方医科大学附属广东省人民医院(广东省医学科学院)呼吸与危重症医学科,广州510080

出　　处：《国际呼吸杂志》2024年第8期958-964,共7页International Journal of Respiration

基　　金：国家重点研发计划(2023YFC2507104)

摘　　要：目的:分析11例上腔静脉支架置入术联合载药微球支气管动脉化疗栓塞(DEB-BACE)治疗的难治性非小细胞肺癌(NSCLC)合并上腔静脉综合征(SVCS)患者的诊治情况。方法:本研究为观察性研究,采用非随机抽样的方法选取2021年11月至2024年4月南方医科大学附属广东省人民医院微创介入科收治的11例上腔静脉支架置入术联合DEB-BACE治疗的难治性NSCLC合并SVCS患者为研究对象。通过医院电子病历系统收集患者性别、年龄、肿瘤最大径、病理类型、临床分期、临床症状、体征、影像学资料、治疗方案、不良事件等临床资料。观察手术前后的临床表现和影像学表现变化,评估近期疗效和不良事件,通过查阅住院病历、门诊病历或电话随访,随访终点时间为2024年5月30日。结果:11例患者中,男9例,女2例;年龄范围38~73岁;肿瘤最大径范围(20~121)mm;鳞癌6例,腺癌5例;临床分期Ⅲ期5例,Ⅳ期6例;3例有神经症状,11例有血流动力学症状,10例有呼吸症状;SVCS分级2级7例,3级4例;术前72 h Kishi评分≥4分11例;TypeⅠ型1例,TypeⅡ型1例,TypeⅢ型0例,TypeⅣ型9例;Grade A型0例,Grade B型7例,Grade C型4例。术后72 h,11例患者中4例患者无明显症状体征,5例表现为咳嗽,1例表现为咯血,1例表现为咳嗽伴气促,所有患者均无神经症状和血流动力学症状;SVCS分级均为0级;Kishi评分均降至4分以下。11例患者术前颈部增强CT均提示上腔静脉血流受阻,侧支循环明显,胸部增强CT均可见肺或纵隔占位性病变侵犯上腔静脉,侧支循环明显。所有患者均一次性成功置入上腔静脉支架,技术成功率100%,上腔静脉支架置入术后即刻造影,观察到受累上腔静脉明显扩张,血流通畅。术后1个月复查颈部和胸部增强CT均提示上腔静脉血流通畅,侧支循环减少,仅1例患者肿瘤较前增大,其余患者肿瘤较前缩小或保持不变。术后1个月评估近期疗效,客观缓解率为27Objective To analyze diagnostic and therapeutic conditions of 11 patients with refractory non-small cell lung cancer(NSCLC)combined with superior vena cava syndrome(SVCS)treated with superior vena cava stenting and drug-eluting beads transbronchial arterial chemoembolization(DEB-BACE).Methods This was an observation study involving 11 patients with refractory NSCLC combined with SVCS,who were treated with superior vena cava stenting combined with DEB-BACE in the Department of Interventional Radiology of Guangdong Provincial People′s Hospital of Southern Medical University from November 2021 to April 2024 by non-randomized sampling.Clinical data,such as gender,age,maximum diameter of tumor,pathological type,clinical stage,clinical symptoms,signs,imaging data,treatment plan,and adverse events were collected from the hospital electronic medical record system.Changes in clinical and imaging manifestations before and after surgery were observed,and recent efficacy and adverse events were assessed.Follow-up was conducted by reviewing inpatient medical records,outpatient medical records,or telephone contact,with the endpoint of follow-up on May 30,2024.Results Of the 11 patients at the age of 38-73 years,9 were male and 2 were female.The maximum tumor diameter ranged from 20 mm to 121 mm.There were 6 cases of squamous carcinomas and 5 cases of adenocarcinomas.Five patients were in clinical stageⅢ,and 6 in stageⅣ.Neurological,hemodynamic and respiratory symptoms were reported in 3,11 and 10 cases,respectively.SVCS grade 2 and 3 were observed in 7 and 4 cases,respectively.Preoperative Kishi score within 72 h of 4 and above was graded in 11 cases.TypeⅠ,Ⅱ,ⅢandⅣwere detected in 1,1,0 and 9 cases,respectively.Grade A,B and C were detected in 0,7 and 4 cases,respectively.At 72 h postoperatively,4 out of 11 patients did not have obvious clinical symptoms and signs,but 5 had cough,1 had hemoptysis,and 1 had cough and shortness of breath.Neurological or hemodynamic symptoms were not observed in all patients.SVCS cla

关 键 词：癌 非小细胞肺 上腔静脉综合征 上腔静脉支架置入术 载药微球支气管动脉化疗栓塞 血管内操作 

分 类 号：R734.2[医药卫生—肿瘤] R543.6[医药卫生—临床医学]