^(32)P胶体囊内放疗治疗颅咽管瘤药物分布的研究  

Drug distribution in intracystic ^(32)P colloid radiotherapy for treatment of craniopharyngioma: a clinical study

作　　者：常洪波[1,2] 高铭[3] 赵思源[1,2] 卢旺盛[1,2] 王亚明[1,2] 赵虎林[1,2] 田增民[1,2] 

机构地区：[1]第二军医大学海军临床医学院 [2]海军总医院神经外科,北京100048 [3]北京军区总医院附属八一儿童医院实验室,100010

出　　处：《中国微侵袭神经外科杂志》2014年第7期289-291,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：首都医学发展科研基金(编号:2009-2053)

摘　　要：目的研究不同药量及颅咽管瘤囊腔容积对32P胶体囊内分布及脑脊液囊内渗漏的影响,为手术穿刺路径的选择及操作技术控制等提供临床指导。方法前瞻性研究分析40例初次发病或复发性囊性颅咽管瘤病人的临床资料,按治疗剂量毫居里(mCi)分为4组:0.5 mCi组、1.0 mCi组、1.5 mCi组、2.0 mCi组。术中将32P胶体用碘帕醇300注射液按1∶1稀释后,行囊内注射立体定向放射治疗,术后2 h内行头颅CT检查观察药物分布及渗漏情况,并比较组间差异是否有统计学意义。结果因脑内穿刺路径不能避开脑室导致药物分布不均匀和脑脊液囊内渗漏,在2.0 mCi组有6例,1.5 mCi组2例,1.0 mCi组1例;渗漏后囊腔体积无明显缩小。其余病人药物分布均匀、无脑脊液囊内渗漏,术后囊腔体积明显缩小。2.0 mCi组脑脊液的渗漏率与1.0 mCi组和0.5 mCi组比较,差异均有统计学意义(P<0.05)。结论颅咽管瘤囊腔容积越大,32P胶体剂量越高,越容易发生脑脊液囊内渗漏及药物分布不均匀。Objective To research the influence of different doses and craniopharyngioma cavity volumes on the drug distribution inside the capsule and cerebrospinal fluid leakage of 32P colloid inside the capsule, so as to provide clinical guidance for the surgical puncture path selection and operation skills control. Methods Clinical data of 40 patients with first onset or recurrent cystic craniopharyngioma were analyzed prospectively, and the patients were divided into 4 groups according to the therapeutic dose （mCi）： 0.5, 1.0, 1.5 and 2.0 mCi groups. After 32P colloid diluted with iopamidol 300 injection by 1：1 proportion, the mixture was injected into the capsule for stereotactic radiotherapy, and the situation of drug distribution and leakage were observed by CT scan 2 h after the operation. The statistical differences were compared between the groups. Results There were 6 patients in 2.0 mCi group, 2 in 1.5 mCi group and 1 in 1.0 mCi group showed uneven distribution of drugs and cerebrospinal fluid leakage inside the capsule, due to puncture pathway in the brain could not avoid entering into the ventricle, and the capsule volume had no obvious shrink after leakage. Even distribution of drug and no leakage were seen in the other patients, and the postoperative capsule volume significantly diminished. There was statistical significance in differences of cerebrospinal fluid leakage rate between 2.0 and both 1.0 and 0.5 mCi groups （P〈0.05）. Conclusion The bigger the cystic craniopharyngioma cavity volume and the greater the 32P colloid dose is, the higher the incidence of cerebrospinal fluid leakage inside the capsule and the more uneven the distribution of drug is.

关 键 词：颅咽管瘤 囊性 磷 药物分布 放射外科手术 

分 类 号：R739.41[医药卫生—肿瘤] R651.1[医药卫生—临床医学]