Jiang Guo-Min, Zhao Jin-Wei, Chen Ya-Xian, Tian Feng
Department of Interventional Radiology, The Affiliated Second Peopleos Hospital of Changzhou City, Nanjing Medical University, Changzhou, Jiangsu, 213003, P. R. China.
Ai Zheng. 2006 Jul;25(7):885-7.
BACKGROUND & OBJECTIVE: Interventional treatment has been widely applied to primary lung carcinoma, but seldom applied to pulmonary metastases because the blood supply of pulmonary metastases has rarely been investigated, and the present understanding is controversial. This study was to explore the correlation of the clinical value of bronchial arterial chemotherapeutic infusion (BAI) combined bronchial arterial embolization (BAE) to the blood supply of pulmonary metastases.
Bronchial artery angiography was performed on 33 patients with pulmonary metastases to assess the blood supply and the distribution of pulmonary metastases. BAI was performed on hypovascular nodules, and BAE was performed on hypervascular nodules.
Of the 89 metastatic nodules in the lungs of 33 patients, 63 (70.8%) were located in the mid-medial zone, and 26 (29.3%) in the lateral region of the lung; 56 had abundant blood supply, and 33 had poor blood supply. The blood supply of pulmonary metastases was correlated to the location of metastatic nodules. Most nodules in the mid-medial region had abundant blood supply, while most nodules in the lateral region had poor or had no blood supply (P<0.01). The blood supply of bronchial artery had no correlation to the volume of metastatic nodule (P>0.05). The curative efficacy of BAI and BAE was correlated to the blood supply of bronchial artery. The response rate was significantly higher in the hypervascular nodules treated with BAE than in the hypovascular nodules treated with BAI (71.4% vs. 42.4%, P<0.01). Most pulmonary metastases of hepatic cancer were hypervascular and the lipiodol deposited well in the nodules; during the follow-up, the nodules shrunk significantly and kept stable.
Bronchial artery is the major feeding artery of pulmonary metastases. BAI and BAE are effective in treating pulmonary metastases with abundant blood supply.
介入治疗已广泛应用于原发性肺癌，但很少应用于肺转移瘤，因为肺转移瘤的血供很少被研究，且目前的认识存在争议。本研究旨在探讨支气管动脉化疗灌注（BAI）联合支气管动脉栓塞（BAE）的临床价值与肺转移瘤血供的相关性。
对33例肺转移瘤患者进行支气管动脉造影，以评估肺转移瘤的血供及分布情况。对乏血供结节行BAI，对富血供结节行BAE。
33例患者肺内89个转移结节中，63个（70.8%）位于肺中内带，26个（29.3%）位于肺外带；56个血供丰富，33个血供较差。肺转移瘤的血供与转移结节的位置相关。中内区的大多数结节血供丰富，而外带的大多数结节血供较差或无血供（P<0.01）。支气管动脉血供与转移结节的大小无关（P>0.05）。BAI和BAE的疗效与支气管动脉血供相关。BAE治疗的富血供结节的有效率显著高于BAI治疗的乏血供结节（71.4%对42.4%，P<0.01）。大多数肝癌肺转移瘤为富血供型，碘油在结节内沉积良好；随访期间，结节明显缩小并保持稳定。
支气管动脉是肺转移瘤的主要供血动脉。BAI和BAE对血供丰富的肺转移瘤治疗有效。
