肺癌血供的血管造影再探讨

时间: 2017-09-13 15:00:09 来源:未知 作者:admin 点击:59 次
  

【关键词】  肺肿瘤;血液供应;支气管动脉;肺动脉;血管造影

  [摘 要] 目的:进一步探讨肺癌的血供来源,为介入治疗提供依据。方法:对30例原发性肺癌和5例转移性肺癌进行支气管动脉和肺动脉血管造影检查,分析造影表现。结果:所有肺癌均以支气管动脉供血为主,其中11例可见肺动脉参与供血,占31.4%。结论:应动态地看待肺癌的血供,支气管动脉是肺癌的主要供血来源,肺动脉参与供血与否取决于肿瘤对其侵犯程度,肺动脉对肿瘤的供血随着病灶的增长和肺动脉受侵蚀程度的加重而逐渐减少;超选择性肺动脉造影对显示肺动脉是否参与肿瘤供血很重要。

  [关键词] 肺肿瘤;血液供应;支气管动脉;肺动脉;血管造影

  A Restudy Upon the Blood Supply of The Lung Cancer Angiographic Method

  Abstract:Objective To further investigate the blood supply origin of the lung cancer in order to provide basis for intervetional therapy.Methods The digital subtraction angiography of both the bronchial artery and the pulmonary artery were performed consecutively in 30 cases of the primary lung cancer and 5 of metastasic lung cancer.The angiogramswere reviewed.Results All the 35 cases of lung cancer were mainly fed by bronchial artery.However,the pulmonary artery also supplied the neoplasm in 11 cases (31.4%).Conclusion The blood supply of lung cancer is constantly changeable with development of the disease.Although the bronchial artery is the dominating supplying vessel of lung cancer,the pulmonary artery may supply it,which depend on its invasive degree by tumor.With the tumor grows increasingly and the pulmonary artery invasion by tumor get more and more serious,the blood supply from pulmonary artery to the tumor is decreasing gradually.For the sake of demons trating the supplying blood vessels of tumor from the pulmonary artery,it is necessary and important to perform ultraselective pulmonary arteriography.

  Key words:Lung neoplasms;Blood supply;Bronchial artery;Pulmonary artery;Angiography

  随着动脉内化疗灌注和栓塞等介入技术被广泛应用于肺癌的治疗,进一步明确肺癌的血供来源有着特别重要的临床意义。目前,支气管动脉被一致认为是肺癌的供血动脉,而肺动脉是否参与供血,仍无定论。本文分析了30例原发性肺癌和5例转移性肺癌患者的支气管动脉和肺动脉DSA结果,旨在深入探讨肺癌的血供来源。

  1 材料和方法

  1.1 病例来源 
    
  35例肺癌中,男性28例,女性7例。年龄25岁~78岁(平均56.2岁)。原发性肺癌30例,其中:中央型肺癌22例,周围型肺癌8例;组织学类型:鳞癌19例,腺癌9例,小细胞癌2例;临床分期:Ⅱ期4例,Ⅲ期22例,Ⅳ期4例。转移性肺癌5例。

  1.2 造影方法

  1.2.1 支气管动脉造影(BAG)

  经皮穿刺股动脉或锁骨下动脉,将5F Cobra导管或胃左动脉导管插入胸主动脉,影像监视下寻找支气管动脉开口,寻找成功后,手推非离子型造影剂8 ml~10 ml,行支气管动脉DSA检查。

  1.2.2 肺动脉造影(PAG)

  经皮穿刺股静脉或锁骨下静脉,选用56F端孔或带有侧孔的眼镜蛇导管。在电视监视下,使导管经右房通过三尖瓣进入右室,旋转导管使之进入肺动脉干,借助导丝引导,尽量行超选择插管,将导管送入一侧肺动脉或病变所在的肺叶肺动脉分支。插管到位后,用高压注射器以6 ml/s~10 ml/s的流速注入造影剂20 ml~30 ml,以6帧/s~12帧/s行肺动脉DSA检查。

  1.3 结果分析                      

  所有血管造影资料均由3位以上介入放射医生集体讨论,意见一致者纳入研究对象。

  2 结果

  2.1 BAG                      

  35例肺癌均有不同程度的支气管动脉分支供血,表现为支气管动脉主干增粗、分支增多、迂曲,肿瘤血管呈串珠状、网状或不规则紊乱分布。实质期可见不同程度肿瘤染色,可呈均一浓密染色或偏侧性、地图样染色,其中4例可见支气管动脉与肺循环血管间的分流(BP分流)(见图1)。

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