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目的 观察支气管动脉灌注 (BAI)对中央型支气管肺癌的疗效并进行CT与病理学对照研究。方法 对2 7例经组织学证实的中央型支气管肺癌进行支气管动脉灌注 (BAI)治疗 ,通过对比疗前、疗后CT评价原发灶及纵隔淋巴结等的改变 ;2 1例BAI治疗后限期手术切除 ,对照分析其疗后CT和病理学的表现。结果 疗后病灶较前缩小2 3例 (2 3/ 2 7) ,纵隔肿大淋巴结疗后较前缩小 16例 (16 / 2 2 ) ,BAI治疗后病灶与周围结构关系有改善者 8例 (8/ 19) ,BAI后肺不张明显改善或消失 12例 (12 / 15 ) ,BAI治疗使病变T分期下降 8例 (8/ 2 7) ,使病变N分期下降 1例 (1/2 7) ,临床分期下降 2例 (2 / 2 7)。BAI后病理学检查发现残存肿瘤细胞周围伴有坏死 (10 / 2 1)、间质纤维化 (10 / 2 1)等成分 ,有时可有出血 (1/ 2 1)或钙化 (2 / 2 1)等。BAI后手术切除病例中 ,5 (5 / 2 1)例在原发灶及纵隔淋巴结内均未发现残存肿瘤成分。坏死成分的CT表现为肿瘤中心的不规则低密度区 ,或伴有空洞 (6 / 10 )。其余病理改变没有特征性的CT表现。结论 支气管动脉灌注 (BAI)治疗对中央型支气管肺癌有较好的近期疗效。CT扫描可以从病变大小和密度的改变方面评价BAI的疗效 ,但在反应残存肿瘤及肿瘤坏死、纤维化的构成比等组织学改变方面 ,CT仍有局
Objective To observe the curative effect of bronchial artery infusion (BAI) on central bronchial carcinoma and compare CT and pathology. Methods Twenty-seven patients with central bronchogenic carcinoma confirmed by histology were treated with bronchial artery infusion (BAI). The changes of primary tumor and mediastinal lymph nodes were evaluated by CT before and after treatment. Twenty-one patients underwent BAI Excision, control and postoperative CT and pathological findings. Results After treatment, the number of lesions was reduced by 23 (23/27), 16 (22/22) after mediastinal lymphadenectomy compared with before, and 8 patients (P <0.05) BAI treatment reduced the T stage of the lesion in 8 cases (8/27), reduced the N stage of the lesion in 1 case (1/2 of 7) ), Clinical stage decreased in 2 cases (2/27). Pathological examination of BAI revealed necrosis (10/2 1) and interstitial fibrosis (10/2 1) around the remaining tumor cells, sometimes with bleeding (1/2) or calcification (2/2 1) )Wait. Among the cases of surgical resection after BAI, no residual tumor was found in 5 (21/2) cases of primary tumor and mediastinal lymph nodes. CT of the necrotic component showed an irregular low density region in the center of the tumor, accompanied by a cavity (6/10). The remaining pathological changes have no characteristic CT manifestations. Conclusion Bronchial artery infusion (BAI) has a good short-term curative effect on central bronchogenic carcinoma. CT scan can evaluate the effect of BAI in terms of lesion size and density, but there are still some problems in response to histological changes such as residual tumor, tumor necrosis and fibrosis