肝癌TACE术后残存病灶的判断方法及^(125)I放射粒子治疗后疗效检测  

Methods for judging the residual focus of hepatocellular carcinoma after TACE and for measuring the postoperative effectiveness of radioactive particle ^(125)I implantation

作　　者：伦俊杰 孙建业 胡效坤[2] 殷好治 李子祥[2] 

机构地区：[1]山东省昌乐县人民医院肿瘤科,山东潍坊262400 [2]青岛大学附属医院介入医学中心,山东青岛266011

出　　处：《医学影像学杂志》2014年第12期2125-2128,共4页Journal of Medical Imaging

摘　　要：目的探讨肝癌TACE术后残存病灶的判断方法,125I放射粒子治疗疗效及疗效检测方法。方法 28例接受过1~5次TACE术治疗的肝癌患者共37个病灶,残存病灶确定方式为强化CT扫描10例,强化MRI 8例,PET-CT 6例,肝动脉造影4例。根据治疗计划系统Brachy Interstitial-Therapy Planning System(TPS)制订治疗计划,确定放射粒子数量及位置,肿瘤靶区超出肿瘤影像学边界0.5~1.0cm,行CT引导下125I放射粒子植入治疗残存病灶,定期检测血清AFP变化并与影像学结果做对比。结果强化CT、强化MRI、PET-CT、肝动脉造影均可确定肿瘤残存。28例患者37个病灶,均按计划完成治疗,分别于术后2、4、6、12月复查CT,肿瘤局部控制有效率依次是:100%(37/37)、100%(37/37)、90.9%(36/37)、81.8%(34/37),血清AFP变化并与影像学结果高度一致。结论强化CT和MRI检查是判定肝癌TACE术后残存的首选方法,125I放射粒子治疗残存病灶是有效的,AFP检测是125I放射粒子治疗后有效的疗效判断方法。Objective To explore the methods for judging the residual foucus of hepatocellular carcinoma after transcath‐eter arterial chemoemblization （TACE） as well as for measuring the postoperative effectiveness of radioactive particle 125 I implantation in treating the residual lesions .Methods A total of 37 foci were found in 28 patients treated with TACE for 1~5 times .The methods for determining residual lesions were the enhanced CT for 10 cases ,the enhanced MRI for 8 ca‐ses ,PET‐CT for 6 cases ,and hepatic arteriography for 4 cases ,respectively .Pre-operative plan was made according to Brachy Interstitial‐Therapy Planning System to determine the amount and location of radioactive particle implantation .The target zone should be exceeded 0 .5-1 .0 cm from the tumor zone ,in which the radioactive particle 125 I was implanted un‐der the guidance of CT for the therapy of residual lesions .Meanwhile ,the serum level of AFP was regularly tested and compared with imaging results .Results All of the the enhanced CT ,enhanced MRI ,PET‐CT ,and hepatic arteriography can determine the residual tumors .28 patients with 37 lesions were duly accepted the treatment in line with the plan and re‐examined with CT scan at 2 ,4 ,6 ,and 12 months ,respectively .The local tomor control rates were 100% （37/37） , 100% （37/37） ,90 .9% （36/37） ,81 .8% （34/37） .The serum AFP and imaging were highly consistent .Conclusion The preferred methods to determine the residual lesions after TACE were the enhanced CT and MRI ,125 I seed implantation for therapy of residual lesions was effective .The serum level of AFP was the effective method to judge the efficacy of residual lesions treated with 125 I seed implantation .

关 键 词：肝细胞癌 病灶残存 125 I放射粒子 近距离放射治疗 判断疗效 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学]