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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,是治疗晚期肺癌的一种可供选择的有效方法之一
Objective To investigate the clinical efficacy of pulmonary isolation drug infusion (ILP) in the treatment of advanced lung cancer. Methods 39 cases of unresectable lung cancer, lung function can not tolerate pneumonectomy patients or patients with multiple metastatic lung cancer lung infusion drug infusion chemotherapy, which is established with the systemic circulation of the affected lung / lobe cardiopulmonary bypass and a The initial perfusion concentration was 6mg / L and the cardiac pump flow was (200 ± 5 0) ml / min. The mean pulmonary artery pressure was maintained at 20-2 mmHg (1mmHg = 0.133kPa) 3 7 ℃) perfusion, continuous flow 45min. Results (1) Before and after perfusion, vital signs were stable. ILhP, PVR and PAP increased, PaO2 decreased, but circulatory stability increased after ILP. (2) Pulmonary isolation was complete during perfusion, and an effective intrapulmonary plasma concentration [(4.05 ± 1.04) mg / L ~ (4.19 ± 0.33) mg / L] could be achieved. (3) tumor necrosis rate of 97.9%. (4) The total effective rate of cancer treatment 89.7%. (5) 1-year survival rate of 76.9%. (6) Postoperative complications were mainly lung injury, but lung injury was reversible at the initial infusion of doxorubicin at 6 mg / L. Conclusion ILP directly administered through pulmonary artery can significantly improve the concentration of local chemotherapy drugs and improve the 1-year survival rate of patients, which is an effective and effective alternative for the treatment of advanced lung cancer