Ratto G B, Toma S, Civalleri D, Passerone G C, Esposito M, Zaccheo D, Canepa M, Romano P, Palumbo R, De Cian F, Scarano F, Vannozzi M, Spessa E, Fantino G
Department of Patologia Chirurgica, University of Genoa, Italy.
J Thorac Cardiovasc Surg. 1996 Sep;112(3):614-22. doi: 10.1016/S0022-5223(96)70043-0.
A multimodality approach including operation and isolated lung perfusion with platinum was used in six patients with lung metastases from soft tissue sarcomas. Staged thoracotomies were used in two patients with bilateral lesions. The inclusion criteria generally applied for surgical excision were adopted in this study. The pulmonary artery and a portion of the left atrium were isolated from systemic circulation and cannulated. The cannulas were then connected to a perfusion circuit and normothermic isolated lung perfusion was done for 60 minutes. The lung was then flushed and metastasectomy was done. Serial blood (systemic and pulmonary), tissue (normal lung and tumor), and urine samples were obtained for platinum content measurement by flameless atomic absorption spectroscopy. Lung damage was assessed by light and electron microscopy examination and by serial respiratory tests. Isolated lung perfusion was accomplished in all patients without any death, operative complication, or systemic toxicity. After operation, interstitial and alveolar edema developed in two patients (48 hours after treatment), necessitating respiratory support in one case. Total platinum concentrations in pulmonary plasma were about 43 times greater than those in systemic plasma. No differences in platinum concentrations between normal lung and metastatic tissue were found. Thus the proposed isolated lung perfusion technique is feasible and safe enough to be offered as a valid model to study combined chemosurgical approaches in the treatment of lung metastases.
对6例软组织肉瘤肺转移患者采用了包括手术和铂介导的离体肺灌注在内的多模式治疗方法。对2例双侧病变患者采用了分期开胸手术。本研究采用了一般适用于手术切除的纳入标准。将肺动脉和部分左心房与体循环隔离并插管。然后将插管连接到灌注回路，进行60分钟的常温离体肺灌注。随后冲洗肺部并进行转移瘤切除术。采集系列血液（体循环和肺循环）、组织（正常肺组织和肿瘤组织）及尿液样本，通过无火焰原子吸收光谱法测定铂含量。通过光镜和电镜检查以及系列呼吸测试评估肺损伤情况。所有患者均成功完成离体肺灌注，无死亡、手术并发症或全身毒性反应发生。术后，2例患者（治疗后48小时）出现间质和肺泡水肿，其中1例需要呼吸支持。肺循环血浆中的总铂浓度约为体循环血浆中的43倍。未发现正常肺组织和转移瘤组织之间的铂浓度存在差异。因此，所提出的离体肺灌注技术足够可行和安全，可作为研究联合化学手术方法治疗肺转移瘤的有效模型。
