摘要
目的研究联合应用光动力疗法和经皮氩氦系统冷消融,对不能切除性非小细胞性阻塞性肺癌的治疗价值。方法41例非小细胞性阻塞性肺癌患者,或者因为肿瘤局部进展(按TNM分期为Ⅲb期),或者因为肺功能差(严重阻塞性肺病),被认为是不能切除性的。先予光动力疗法。静脉注射光敏剂Photofrin 2mg/kg(或血卟啉5mg/kg,华鼎药业),48和72小时分别在支气管镜下输入630nm红色激光照射;再在B超或CT引导下通过氩氦系统进行经皮冷消融。按症状、肿瘤大小和生存期判断疗效。结果41 例经此种联合疗法治疗后,90.2 %的患者主观症状有不同程度改善,症状积分治疗后明显降低,呼吸困难的改善最为明显;支气管镜复查,发现全部患者支气管内肿瘤均得到不同程度消融,其中41.5%完全消失;CT复查发现肺内肿瘤CR 34.1%,PR 41.4%;X线片上,原有肺塌陷的病例中29.6%的塌陷完全消失,70.4%的肺塌陷减轻;半年和1年生存率分别达44和71%。无论光动力抑或经皮氩氦系统冷消融,均未发生严重并发症。结论联合应用光动力疗法和氩氦系统经皮冷消融,能分别消除支气管内、外的病变,两者相辅相成,因而可提高不能切除性非小细胞性阻塞性肺癌的治疗效果。
Objective To investigate the therapeutic efficacy of combined photodynamic therapy and percutaneous cryoablation with argon-helium system for unresectable,obstructive non-small cell lung carcinoma.Method Forty-one patients with obstructive non-small cell lung carcinoma,whose tumors were considered nonresectable because of local aggression of tumor (stage Ⅲb on TNM)or poor lung function of patients(severe obstructive lung disease),were given the combination therapy.At first, photodynamic therapy was performed.Patients received with photosensitizer (Photofrin 2mg/kg or Hematoporphyrin 5mg/ kg),intravenous infusion,and 48 and 72 hours later,630nm red laser illumination through bronchoscopy. Then,percutaneous cryoablation with argon-helium system under guidance of B-mode sonography or CT was given.The therapeutic efficacy was estimated according to changes of symptoms tumor size and survival. Results Among 41 patients received the combination therapy,90.2 percent had some improvement of subjective symptoms,significant decrease of symptom score, especially marked relief of dyspnoea. Bronchoscopy showed that endobronchial tumor was ablated on different degrees in all patients, with complete resolution in 41.5 % of patients.CT showed that lung tumor had CR of 34.1% and PR of 41.4%. According to the radiographic evidence,collapse of lung resolved completely in 29.6% of patients with previous collapse, and diminished in 70.4% of patients.The 6- and 12-month survival were 44% and 71% respectively.There were no severe complications in photodynamic therapy or percutaneous cryoablation with argon-helium system.Conclusion Combination of photodynamic therapy and percutaneous cryoablation with argon-helium system can eliminate endo- and extra-bronchial tumor masses,respectively, and is complementary to each other,therefore,raise the therapeutic efficacy for unresectable obstructive non- small cell lung carcinoma.
出处
《国际医药卫生导报》
2004年第20期13-16,共4页
International Medicine and Health Guidance News
关键词
非小细胞性肺癌
治疗
光动力疗法
冷消融
氩氦系统
Non-small cell lung cancer Treatment Photodynamic therapy Cryoablation Argon-helium system
