食管内照射支架的研制及临床应用的初步结果  

Esophageal intraluminal irradiation stent: primary results of development and clinical application(

作　　者：郭金和[1] 滕皋军[1] 何仕诚[1] 邓钢[1] 杜明华[2] 方文[1] 朱光宇[3] 

机构地区：[1]东南大学附属中大医院放射科,南京210009 [2]东南大学附属中大医院核医学科,南京210009 [3]东南大学附属中大医院放射科核医学科,南京210009

出　　处：《中华放射学杂志》2004年第9期916-920,共5页Chinese Journal of Radiology

基　　金：江苏省卫生厅医学科技发展基金 (H2 0 0 3 43 )

摘　　要：目的　探索食管内照射支架研制、临床使用的可行性、安全性及初步疗效。方法　选择合适的覆膜或裸食管支架 ,于支架外周按一定的规律固定上特制的可容纳放射粒子的鞘 ,根据患者病变的范围通过治疗计划系统 (treatmentplansystem ,TPS)计算出放射粒子的剂量 ,将放射粒子装进上述鞘内即制成食管内照射支架。临床选择 15例食管癌患者 ,临床分级为Ⅱ～Ⅳ级 ,将放疗支架植入到患者病变食管内并进行临床随访。结果　 15例患者内照射支架均释放到位 ,释放过程顺利 ,释放过程中未出现放射粒子脱落现象 ;全身γ射线显像 (ECT)复查未发现非靶器官显像 ;患者全身一般状况明显好转 ,血象和免疫指标亦未见明显变化 ,未出现如食管穿孔、出血等并发症 ;13例术后 1个月CT复查提示病灶的厚度较术前变簿 ,2例变大 ,3例随访近 8个月 ,CT复查病变厚度较术前明显变薄 ,胃镜检查并活检提示支架捆绑粒子部位肿瘤明显缩小 ,活检未发现肿瘤细胞生长。结论　食管内照射支架临床使用是安全、可行、有效的 。Objective To investigate the feasibility, safety, primary clinical effectiveness of development, and clinical application of esophageal intraluminal irradiation stent.Methods The proper stent was first chosen, and the specially made sheath involving radiated particles was fixed outside the stent according to some rules. Based on the size of the tumor focus, the radiated dose of the particles was computed through TPS system, and the particles were put into the sheath, then the esophageal intraluminal irradiation stent was finished. Esophageal intraluminal irradiation stents were placed in 15 patients with esophageal cancer of Ⅱ-Ⅳ grade esophageal carcinoma, and the clinical effectiveness was observed.Results(The finished) stents were put into the sites of 15 diseased esophagus, and the released process was successful without dropping off of the particles. No radiated source leakage was discovered through the ECT examination. The patients’ general conditions improved obviously, neither hematological nor immunological examination changed obviously, nor complications such as esophageal perforation or hematorrhea. In (13 patients,) the focus thickness was thinner markedly after 1 month through CT examination, and 2 of them became lager. 3 of the patients were followed for 8 months, and the focus thickness was thinner obviously through CT examination. On the sites of fixed particles, the tumors obviously drew back and no cancer cells showed growing through gastroscopy and biopsy. Conclusion Esophageal intraluminal irradiation stent is safe, feasible, and effective, and its long-term clinical effectiveness still needs further follow-up observation and comparative research.

关 键 词：食管 内照射 支架 患者 临床应用 放射 CT复查 提示 过程 粒子 

分 类 号：R735.1[医药卫生—肿瘤] R655[医药卫生—临床医学]