经纤维支气管镜插管腔内放射治疗肺癌(附16例报告)

目的高剂量率腔内放射治疗肺癌腔内侵犯疗效观察。方法选择肺癌腔内侵犯患者１６例，经纤维支气管镇插入后装治疗管，与ＳＫ－Ⅱ型近距只后装治疗机连接进行放疗。剂量为每ｄ５Ｇｙ，每周１次，共照４次。结果纤维支气管镜检查示肿瘤消退，管腔通畅１２例，癌肿部分消退，管腔增宽４例。总有效率１００％。结论高剂量率腔内放射治疗肺癌腔内侵犯，可快速消除梗阻，缓解症状，是一种简单、安全、有效的治疗方法。     

高剂量率支气管内近距离放疗根治局限性支气管内肺癌

随着小型化放射源~(192)Ir及后装机技术的发展,目前 已能对支气管腔内肺癌进行近距离放疗。现在提倡的高剂量率(HDR)(>10Gy/h)支气管内近距离放疗具有下列优点:缩短治疗时间。便于门诊病人;剂量与放射源距离呈反平方关系。迅速衰减,故治疗区严格限制于肿瘤及其周边组织,给予病人以最大的放射保护。该方法已面功应用于解除肿瘤性支气管阻塞及联合外照射根治支气管腔内肺癌,但用于支气管内小病灶的根治性治疗仅适用于少数病例。本文旨在研究HDR支气管内近距离放疗对于因严重呼吸衰竭或原先已经治疗而不适合采用其他治疗的局限性支气管内肿瘤患者作为单一治疗的应用价值。     

PHOTOFRIN光动力治疗晚期梗阻性支气管肺癌

目的 探讨内镜下光动力治疗晚期梗阻性支气管肺癌以观察其疗效和不良反应。方法 28例晚期梗阻性支气管肺癌患者均经过化疗、放疗或其他方法治疗无法消除肿瘤,光敏剂为PHOTOFRIN,按2mg/kg体重静脉滴注,48h后经内镜导入光导纤维给以630nm（DIOMED半导体激光治疗仪）激光照射治疗,72h后经内镜清除坏死组织并对原有病灶和新发现病灶给以复照,之后根据具体情况对患者的病灶部位清除坏死组织。结果光动力治疗后晚期梗阻性支气管肺癌PDT治疗总有效率为85.8%,气道梗阻缓解率为90.0％,KPS评分也较治疗前有明显改善。结论 光动力治疗晚期梗阻性支气管肺癌能够有效的解除腔道梗阻,患者耐受性好,能明显改善患者的生存质量,不良反应轻,光动力治疗对晚期梗阻性支气管肺癌不失为一种好的姑息治疗手段。     

双途径联合化疗肺癌胸腔积液的疗效观察

目的　观察应用双途径联合化疗治疗恶性胸腔积液的临床疗效。方法　将 3 9例肺癌恶性胸腔积液患者随机分成 2组 ,治疗组 19例 ,采用PICC管 (外周穿刺中心静脉导管 )行胸腔闭式引流 ,8～ 48h内引流近乎消失后注入DDP 60～ 80mg ,术后d1～ 5予EP或NP方案化疗 1个周期 ,4周重复 ;对照组 2 0例 ,采用胸腔抽液 ,腔内注入DDP 60～ 80mg化疗 ,d4～ 9后重复 1次。结果　治疗组CR3 1 6% ( 6/19) ,有效率为 84 2 % ( 16/19) ;对照组CR 15 % ( 3 /2 0 ) ,有效率为 5 5 % ( 11/2 0 )。结论　双途径联合化疗治疗恶性胸腔积液疗效满意 ,安全、可靠 ,值得临床推广应用     

50例肺癌的高剂量率后装腔内放疗

目前,肺癌单纯外照射失败的原因主要是局部未控和远处转移。而局部未控往往是肺内病灶接受足量外照射后,X线、CT片虽显示肿瘤消退,但支气管腔内仍有肿瘤残存。对这部分病例的继续治疗是极其困难的。高剂量率后装腔内治疗(HDR)有效地解决了支气管腔内残存癌的问题,而且对肿瘤阻塞支气管、X线显示肺不张的病例,在打通气道方面效果显著,对术后残端阳性或复发的病例也可做到有效的控制,临床应用HDR治疗原发性支气管肺癌50例,收到了令人满意的疗效。     

纤维支气管镜治疗气管支气管管腔内肿瘤的研究

目前已有多种支气管镜技术用于气管支气管管腔内肿瘤的治疗，尤其对于良性肿瘤及早期的管腔内恶性肿瘤，支气管镜治疗能达到治愈的目的，某些情况下可替代手术治疗，如光动力治疗（photodynamic therapy，PDT）在西方国家已作为影像隐匿肺癌（roentgenologically occult lung cancer，ROLC）的主要治疗手段之一。[第一段]     

非小细胞肺癌根治术后支气管残端复发的放射治疗

目的探讨非小细胞肺癌根治术后支气管残端复发放射治疗的疗效及毒性反应。方法21例根治术后支气管残端复发的非小细胞肺癌患者行放射治疗,19例采用体外照射,剂量为44~68Gy/22~34次/5~7周。2例行支气管腔内近距离放疗。结果33.3%(7/21)的患者肿瘤完全缓解,42.9%(9/21)的患者肿瘤部分缓解,症状缓解率为81.0%(17/21),中位生存期为22个月,1、3、5年生存率分别为66.7%、26.6%、14.2%,7例患者死于远处转移,10例患者死于局部进展。5例伴有纵隔淋巴结的残端复发癌患者均于治疗后6个月内死亡。结论非小细胞肺癌根治术后支气管残端复发行放射治疗安全有效,毒副反应可以耐受。不伴纵隔淋巴结的患者治疗后有可能长期生存。     

经鼻介入微波治疗恶性气管狭窄

自1997年以来,我们对86例晚期肺癌气管狭窄患者采用经纤支镜介入微波电灼治疗,疗效满意。总结报告如下。1　临床资料1.1　一般资料本组男55例,女31例;年龄18～74岁。其中,气管狭窄为重度(小于原管腔直径的1/3)29例,中度(小于原管腔直径的1/2,大于原管腔直径的1/3)37例,轻度(大于原管腔直径的1/2)20例。狭窄部位为气管16例,左主支气管24例,左下叶支气管6例,左舌叶支气管4例,右主支气管22例,右上叶支气管5例,右中叶支气管3例,右下叶支气管6例;其中两处同时狭窄16例。全组病例均经病理和/或细胞学检查确诊为肺癌。1.2　治疗方法术前禁水、食。…     

管支架治疗肺癌引起的气管支气管狭窄5例报告

管支架治疗肺癌引起的气管支气管狭窄５例报告李留树董生朱顺荛刘天星白杨袁瑞康朱建华关键词肺肿瘤管支架气管支气管狭窄中图号Ｒ７３４，１原发性支气管肺癌约１／３患者肿块位于支气管腔内引起阻塞性肺炎或肺不张，严重者可导致呼吸道梗阻。我们采用镍钛合金支架治疗５...     

CT仿真支气管内窥镜在中央型肺癌诊断中的应用

目的：评价螺旋CT仿真支气管内窥镜（CTVB）在中央型肺癌诊断中的作用。方法对45例经纤维支气管检查和病理证实的气管、支气管肿瘤患者进行CT仿真内窥镜检查，包括中央型肺癌33例、肺癌术后8例，肺癌放疗后2例及气恶性肿瘤2例。用新型螺旋CT机对患者进行扫描后，将数据建成CTVB图像进行分析，并与纤维支气管镜进行对照，24例与病理标本进行对照。结果CTV显示了100％的段以上支气管和80％以上的亚段支气管，肿瘤呈块状或结节状，引起管腔狭窄或闭塞。肺癌术后正常的支气管残端呈光滑的盲端，肿瘤复发呈结节状突出，与纤维支气管镜所见基本一致，肺癌放疗后支气管腔轻度凹凸不平及管腔狭窄，结论CTVB是一种新的无创性观察气管、支气管腔的方法、酷似纤维支气管镜所见，结合其他三维重建功能，能同时显示管壁的厚度和肿瘤向管腔外侵犯的范围，但与纤维支气管镜相比，不易观察支气管黏膜的表浅病变且不能活检。     

Predicting the response of obstructive endobronchial tumors to photodynamic therapy

To investigate the usefulness of bronchoscopic examination, computerized tomography (CT), and radionuclide quantitative ventilation-perfusion lung scan to determine the response of patients with obstructive endobronchial tumors to photodynamic therapy (PDT), the findings in 24 patients treated with PDT were analyzed. PDT was found to be most effective when the tumor was bronchoscopically polypoid in appearance, with little or no submucosal invasion or peribronchial extension seen on CT scans. With increasing submucosal and/or peribronchial extension, the immediate response to treatment was poorer. Patients who had 50% or more of the airway obstruction due to mucosal tumor had no evidence of local tumor recurrence for a median interval of 22 weeks after treatment. In patients with predominant submucosal and/or peribronchial tumor, the duration of response was 7 weeks. Response to treatment did not correlate with the degree of airway obstruction. CT provided valuable information regarding the extent of the peribronchial involvement and airway distortion, which was often underestimated by bronchoscopy alone. Absent perfusion or reduction of regional perfusion out of proportion to ventilation on scintigraphy in the involved lung zone was found to be associated with extensive peribronchial involvement and a poor outcome. The authors conclude that the addition of CT and radionuclide quantitative ventilation-perfusion lung scan to bronchoscopic examination is useful in predicting the response of patients with obstructive endobronchial tumors to PDT.     

16层螺旋CT血管造影及三维重建和CT仿真内镜技术在肺癌血供诊断中的价值

背景与目的:以往主要靠主动脉或支气管动脉血管造影了解肺癌的供血血管及血供,但该方法具有较大的创伤性且操作复杂,部分病人不易接受,一次血管造影不能保证显示全部供血血管,且支气管动脉血管造影成功率较低.本研究探讨16层螺旋CT血管造影及三维重建和CT仿真内镜技术诊断与评价肺癌供血血管和血供的临床应用价值,为肺癌血供诊断提供一种无创伤性、安全、简便、全面有效的检查方法.方法:对72例经病理证实肺癌患者行16层螺旋CT血管造影及三维重建,血管三维重建方法包括容积再现技术(volume rendering,VR)、最大密度投影(maximum intensity projiection,MIP)和表面遮盖成像(surface shaded display,SSD).其中25例行支气管动脉CT仿真内镜(CT virtual endoscopy,CTVE)成像.每个肺癌病灶同时行VR彩色三维成像,用肺癌病灶VR彩色图像红色色彩程度代表其血供状况.结果:68例肺癌血管三维重建显示供血血管,其中59例肺癌仅见支气管动脉;5例肺癌仅见肋间动脉:4例肺癌呈混合型,包括支气管动脉、肋间动脉和锁骨下动脉分支血管.4例肺癌纵隔转移淋巴结见支气管动脉进入其内.25例肺癌支气管动脉CTVE可较好显示其开口及血管内腔状况.72例肺癌VR彩色图像红色色彩程度分为4种类型:无色彩(11例),轻度(17例),中度(32例)和重度(12例),其增强后增加CT值分别为(6.16±2.23)Hu,(15.71±3.13)Hu,(25.47±2.71)Hu,(44.31±19.68)Hu.72例肺癌VR彩色成像红色色彩分布形态与其CT强化形态两者一致率为86.1%.结论:16层螺旋CT血管造影及三维重建和CT仿真内镜技术可较好显示肺癌供血血管及血供状况,是诊断与评价肺癌血供一种无创伤性、简便、有效方法.     

光动力疗法疗膀胱癌：附30例分析

Thirty patients with bladder carcinoma treated by photodynamic therapy (PDT) with hematoporphyrin derivative are presented. 24, 48 and/or 72 hours after intravenous injection of DHE 1.5-2.0 mg/kg or Y-HpD 5.0 mg/kg, the tumor was irradiated with 630 nm wavelength of argon dye laser via a quartz optic fibre inserted through the forceps channel of the cystoscope. Of the 30 patients treated, CR was obtained in 14 cases, PR in 13 cases and NR in 3 cases 1-3 months after therapy with a total effective rate of 90%. Among the 78 tumors found in the 30 cases, 52 were completely eradicated with a eradication rate of 66.7%. Photodynamic therapy is therefore useful in the treatment of transitional-cell carcinoma of the bladder. Yet, controlled trials are required to assess its place in the combined treatment of carcinoma of the bladder. Post PDT morphologic changes in the tumor, side effects, indication, advantages and disadvantages of this therapy are discussed.     

隆凸切除及重建术治疗隆凸肿瘤及支气管肺癌35例经验

目的：探讨隆凸切除及重建术治疗隆凸,主支气管肿瘤及中央型支气管肺癌的手术方式及围术期管理。方法：隆凸,主支气管肿瘤8例,中央型支气管肺癌27例,其中侵犯左心房5例,行单纯隆凸切除重建5例,右上肺叶切除及隆凸切除重建18例,右全肺隆凸切除4例,左全肺隆凸切除4例,右上肺叶切除及隆凸切除重建4例,加行部分左心房切除5例,手术采用了11种不同类型的隆凸切除重建方式。结果：本组无手术死亡,无吻合口瘘,肺部感染7例,呼吸功能不全1例,全肺不张1例,隆凸,主支气管肿瘤患者术后无瘤生成17月－7年,中央型支气管肺癌患者术后1年生存率96．3％,3年生存率70．1％,5年生存率37．0％,有5例生存10年以上。结论：通过仔细术前评估,熟练的手术操作,良好的术后管理,配合术后综合治疗,可大大降低隆凸手术的死亡率和并发症,并获得满意的远期效果。     

Photodynamic therapy, Nd-YAG laser and electrocautery for treating early-stage intraluminal cancer: which to choose?

The degree of healing and damage of the bronchial wall after photodynamic therapy, Nd-YAG laser and electrocautery for intraluminal early-stage cancer have been analysed. Review of the bronchoscopy reports and follow-up histology specimens of twenty-nine patients treated bronchoscopically with curative intent for their intraluminal tumor have been performed. Seventeen patients had been treated with bronchoscopic electrocautery (BE) only, six with photodynamic therapy (PDT) and six with Nd-YAG laser. Bronchial wall scarring seen during follow-up bronchoscopy was scored and subepithelial fibrosis were histologically evaluated using Alcian blue staining, Azan staining and polarised light. After BE, prominent airway scarring was seen in five patients (29%), with significant stenosis (>50% lumen) in one of these cases. Prominent scarring and significant stenosis were found in four (67%), after PDT. In five (83%) after Nd-YAG laser prominent scarring was found, one patient had significant stenosis. In three cases, two after BE and one after PDT, subepithelial tissue in the follow-up biopsies was insufficient for proper histologic examination. In the remaining biopsy specimen only one (7%) showed a moderate or excessive amount of fibroblasts after BE, whereas for PDT and Nd-YAG this was found in three (60%) and four patients (67%), respectively. Excessive matrix was found in none of the biopsies after BE, in two (40%) after PDT and in three (50%) after Nd-YAG laser. Compact collagen formations were seen in two (12%) biopsies after BE, in two (40 and 33%) after PDT and Nd-YAG, respectively. Compared to electrocautery, more airway scarring and more subepithelial fibrosis were seen after treatment with PDT and Nd-YAG laser. These findings, especially regarding PDT, is in contrast to the assumption that PDT is selective and may be important in the choice of treatment for patients with early stage cancer.     

Long-term results of endobronchial brachytherapy: A curative treatment?

PURPOSE: To evaluate outcomes after high-dose-rate endobronchial brachytherapy (HDR-EBBT) for limited lung carcinoma. METHODS: A total of 106 patients with endobronchial lung cancer and not eligible for surgery or external beam radiotherapy, without nodal or visceral metastases, were treated with HDR-EBBT. They had developed disease relapse after surgery (n = 43) or external beam radiotherapy (n = 27) or had early lung cancer with respiratory insufficiency (n = 36). Treatment consisted of six fractions of 5 or 7 Gy, usually delivered 1 cm from the source. RESULTS: The complete histologic response rate, evaluated at 3 months after HDR-EBBT, was 59.4%. At 3 and 5 years, the local control, overall survival, and cause-specific survival rates were 60.3% and 51.6%, 47.4 and 24%, and 67.9 and 48.5%, respectively. Factors significantly associated with local failure were high tumor volume (tumor length >2 cm, bronchial obstruction >25%, tumor visibility on CT scan) and previous endoscopic treatment. Cause-specific survival, but not overall survival, was significantly associated with local control, probably because of the high rate of deaths not related to lung cancer. Five deaths were attributed to the HDR-EBBT procedure (two from fatal hemoptysis and three from bronchial necrosis). CONCLUSION: High-dose-rate-EBBT achieved a long-term cause-specific survival rate of 50% of the patients with localized endobronchial carcinoma and could be considered curative.     

Photodynamic therapy for peripheral lung cancer

Photodynamic therapy (PDT) has now achieved the status of a standard treatment modality for centrally located early-stage lung cancer. In the last decade, CT screening for lung cancer has attracted much attention for its ability to detect early peripheral lung cancer. Extremely recently, treatment using PDT has been introduced for the first time in patients with peripheral lung cancer, who did not meet the previous criteria for surgery. The procedure was carried out with local anesthesia with xylocain infiltrated into the chest wall, 48 h after Photofrin administration. Needles (19 gauge) containing an internal catheter were inserted percutaneously under CT guidance. The needles were then extracted and a diffuser fiber with a 2 cm long tip for light delivery was positioned in the tumor through the catheter. Of the nine patients enrolled in this trial, seven achieved partial remission (PR). No serious complications, except for two cases of pneumothorax, were noted. As an increasing number of patients consider quality of life after therapy, the indications for PDT are expected to expand. We conclude that PDT is a promising new technique for curative treatment of localized, peripheral lung cancer less than 1cm in size in patients who are unfit for surgery or radiotherapy.     

Primary lung cancer complicated with pneumothorax.

Eighteen lung cancer patients with a pneumothorax complication were studied. Pneumothorax appears rarely in lung cancer patients, having been found in 18 out of 5567 (0.32%) at our hospital over a period of ten years. Of the 18 patients, eight had adenocarcinoma, seven epidermoid carcinoma and three alveolar cell carcinoma. Unlike those of previous reports, our results showed pneumothorax not to be found exclusively on the same side as the lung cancer. It was contralateral in five cases. Pneumothorax was the initial manifestation of lung cancer in three cases and occurred as a complication in another 15. Of these 15 patients, 11 were described as developing pneumothorax between one and twelve months after completion of radiation therapy for lung cancer. Another two patients developed pneumothorax following cytotoxic chemotherapy. Pneumothorax occurred prior to any treatment for lung cancer in the remaining two patients. The factors contributing to pneumothorax in the lung cancer patients were the rupture of the necrotic neoplastic tissue into the pleural cavity, the rupture of a subpleural bleb or the formation of interstitial air due to partial bronchial obstruction by the tumor, complications arising from radiation therapy and cytotoxic chemotherapy, or any combination of such factors. Pneumothorax was an ominous sign for the lung cancer patients. Most (12/14) died within six months of the onset of pneumothorax.     

Cytogenetic abnormalities and overexpression of receptors for growth factors in normal bronchial epithelium and tumor samples of lung cancer patients.

A cytogenetic analysis was performed on direct preparations and short-term cell cultures of lung tumor and normal bronchial epithelium of 19 patients carrying either a first or a second primary lung cancer. In 9 tumors (6 squamous cell carcinomas, 1 adenocarcinoma, 1 mucoepidermoid carcinoma, and 1 small cell lung carcinoma) successfully analyzed, pseudodiploid and hyperdiploid karyotypes were observed with a heterogeneous pattern of chromosome abnormalities but with a consistent involvement (5 cases) of the short or the long arm of chromosome 3. The normal bronchial epithelial cells had a normal karyotype in 11 patients, whereas in 6 patients clonal and nonclonal chromosomal abnormalities were observed. Involvement of chromosome 7 was present in 4 cases. In addition, overexpression of the growth factor receptors, epidermal growth factor receptor and HER-2/neu, was found in 9 of 18 tumors and in 6 of 13 bronchial epithelium samples. These findings suggest that early genetic lesions could be present in the normal bronchial epithelial cells that are the target of further complex and multiple genetic changes occurring during the pathogenesis of lung cancer.