CT引导下^125I放射性粒子组织间植入治疗纵隔转移性淋巴结  

CT-guided interstitial brachytherapy for metastatic carcinoma of lymph nodes in mediastinum

作　　者：刘士榕[1] 肖越勇[1] 吴斌[1] 张肖[1] 马旭阳[1] 任超[1] 

机构地区：[1]解放军总医院放射诊断科,北京100853

出　　处：《中华放射学杂志》2011年第12期1190-1193,共4页Chinese Journal of Radiology

摘　　要：目的 探讨CT引导下经皮穿刺^125I放射性粒子植入治疗纵隔转移性淋巴结的技术方法、安全性及临床价值.方法 应用^125I放射性粒子组织间种植治疗纵隔淋巴结转移患者8例,所有患者采用前路进针途径穿刺,按照病灶与体表穿刺点的位置设定CT机架的角度,采用多方位重组技术及平头针芯捻压分离主动脉、上腔静脉间隙进针法植入^125I放射性粒子.疗效评价采用术后治疗计划系统（TPS）,验证放射性粒子种植后剂量分布,观察治疗后患者局部压迫症状（气短、咳嗽、吞咽困难等）的改善情况及粒子植入术后2个月靶淋巴结的局部反应,并记录并发症情况.结果 植入术后粒子覆盖率为（93.5 ±1.5）％.术后2个月复查,其中完全缓解（CR）3例,部分缓解（PR）4例,病灶稳定（SD）1例.5例气短、4例咳嗽和吞咽困难等局部压迫症状均有不同程度减轻,未出现头颈部及上肢水肿.术后无严重并发症发生；无大血管、气管、食管损伤,1例出现少量气胸.结论 CT引导下经皮穿刺组织间放射性粒子植入治疗纵隔4R区肿瘤转移性淋巴结,疗效肯定、安全可靠,为常规治疗局部压迫症状较严重的复杂部位淋巴结转移,提供了一种新的微创治疗方法.Objective To investigate the technique,safety and clinical value of CT-guided percutaneous interstitial brachytherapy for metastatic carcinoma of lymph nodes in mediastinum.Methods Eight patients with metastatic carcinoma of lymph nodes in mediastinum were treated by CT-guided interstitial implant of radioactive seeds in our department.Anterior approach were performed on all cases,125I radioactive seeds were implanted by setting CT Gantry at an oblique angle,three-dimensional reconstruction with SCT and separation the narrow gap between aortic arch and superior vena cava with fiatscalp core.Dose distributions were checked by TPS after operation.The improvement in clinical symptoms and lymph node sizes were documented in order to investigate the therapeutic effects.Results The particle coverage rate was 93.5% ± 1.5%.According to the CT scans two months later,3 patients （ 37.5% ） had complete ablation,4 （50%） partial ablation,and 1 （ 12.5% ） stable disease.Overall response rate （CR ＋ PR） for this group of patients was 87.5%.The symptoms of all patients including shortness of breath （5 patients）,cough （4 patients）,dysphagia （4 patients） showed varying degree of improvement.No edema of head-and-neck and upper extremity was observed.There was no major vascular,tracheal and esophageal injury.A small amount of pneumothorax was observed in one patient.Conclusions CT-guided percutaneous interstitial brachytherapy,a minimally invasive procedure associated with favorable therapeutic results,is a promising technique for treatment of metastatic carcinoma of lymph nodes with local pressure symptoms which may not respond to conventional therapy.

关 键 词：近距离放射疗法 淋巴结转移肿瘤 组织间照射 种植 

分 类 号：R730.5[医药卫生—肿瘤]