摘要
目的 探讨肺隔离药物灌注(ILP)治疗晚期肺癌的临床疗效。方法 对3 9例不可切除的肺癌、肺功能不能耐受肺切除手术者或多发性转移性肺癌患者进行肺隔离药物灌注化疗,即建立与体循环完全隔离的受累肺/肺叶的体外循环并以阿霉素灌注,灌注起始浓度为6mg/L ,心泵流量(2 0 0±5 0 )ml/min分,维持平均肺动脉压在2 0～2 5mmHg(1mmHg =0 .13 3kPa) ,常温(3 7℃)灌注,持续转流45min。结果 (1)灌注前后生命体征平稳,ILP术后1hMPaP、PVR及PAP升高,PaO2 降低,但循环稳定。(2 )灌注时肺隔离完全,能达到有效的肺内血药浓度[(4 .0 5±1.0 4)mg/L～(4 .19±0 .3 3 )mg/L]。(3 )肿瘤细胞坏死率97.9%。(4 )全组肿瘤治疗总有效率89.7%。(5 )术后1年生存率76.9%。(6)术后并发症主要是肺损伤,但阿霉素起始灌注浓度在6mg/L时肺损伤是可逆的。结论 ILP直接通过肺动脉灌注给药,能大幅度提高局部化疗药物的浓度,提高患者的1年生存率。
Objective To study the clinical effects of isolated lung perfusion for terminal lung cancer.Methods Thirty-nine patients underwent this novel therapy due to advanced unresectable lung cancer,multiple metastatic lung cancer or poor lung function.The encroached lung or lobe were totally isolated and then perfused with doxorubicin.The initial perfusate concentration of doxorubicin was 6 mg/L in perfusating volume.The isolated lung perfusion was performed for 45 min at 200-300 ml/min at a mean pulmonary artery pressure of 20-25 mm Hg(1?mm?Hg=0.133?kPa).Results MpaP,PVR and PAP was increased postoperatively while PaO 2 decreased.But the circulation was stable and vital signs were steady.The isolation was effective and thorough during the perfusion.There were sound drug concentrations in the lung (4.05± 1.04) mg/L (4.19± 0.33) mg/L.Tumor necrosis rate was 97.9%. The effective rate (CR+PR) was 89.7%. One-year survival rate after treatment was 76.9%. The main side-effect was lung injury,but it could be well tolerated and reversible within a 6 mg/L doxorubicin initial concentration.Conclusion ILP is technically safe and feasible,which delivering high dose chemotherapeutic agents to local region and increasing one-year survival rate.
出处
《中华实验外科杂志》
CAS
CSCD
北大核心
2005年第4期486-487,共2页
Chinese Journal of Experimental Surgery
基金
湖南省卫生厅科研资助项目 (992 3)
