^(125)I放射性粒子植入联合椎体成形术在椎体转移瘤中的应用  

Value of percutaneous vertebroplasty combined with radioactive seed implantation in the treatment of vertebral metastasis

作　　者：邱国钦[1,2] 许丽贞[1,2] 陈玉强[1,2] 罗鹏飞[3] 

机构地区：[1]厦门大学附属成功医院 [2]解放军第174医院肿瘤中心,福建厦门361003 [3]广东省人民医院介入中心,广东广州510515

出　　处：《影像诊断与介入放射学》2015年第1期74-79,共6页Diagnostic Imaging & Interventional Radiology

基　　金：厦门市科技计划基金资助项目(3502Z20114033)

摘　　要：目的探讨125I放射性粒子植入联合椎体成形术(PVP)治疗椎体转移瘤的疗效和安全性。方法回顾性分析83例胸腰椎转移瘤患者,其中PVP组28例,单纯行CT引导下经皮椎弓根穿刺骨水泥灌注成形术;PVP联合放疗组30例,即PVP术后1周联合外放射治疗;PVP联合粒子组25例,即PVP术中同时结合125I粒子植入治疗;术后随访18个月,比较各组患者疼痛缓解程度和并发症,并评价生存率及局部控制率。结果与PVP组比较,其他两组患者止痛有效率更高且持久,尤其以联合粒子组显著且起效更快;术后1年及18个月患者生存率及局部控制率均以联合粒子组最高而PVP组最低(P<0.05);各组均出现骨水泥渗漏但比较无明显差异,而联合放疗组中出现放疗相关性反应。结论应用PVP联合外放疗或粒子植入治疗椎体转移瘤均具有稳定椎体和抑制肿瘤协同作用,但联合粒子治疗的止痛起效更迅速持久且安全。Objective To investigate the efficacy of combined percutaneous vertebroplasty （PVP） and radioactive seed implantation in the treatment of vertebral metastasis. Methods Eighty-three patients with thoracic vertebral metastasis treated by CT-guided PVP （28）, PVP followed 1 week later by radiotherapy （30）, PVP combined with permanent interstitial implantation of 125I seed （25）. All patients were followed up for 18 months. The degree of pain relief, complications, survival rates and local tumor control rate were compared among the three groups. Results Pain relief was significantly greater and longer with combined PVP and 125I seed implantation（P〈0.05） than that of the other 2 groups..Survival and local control rates were also highest in PVP combined with 125I seed implantation within 12 and 18 months after treatment （P〈0.05）..There was no significant difference in the leakage of polymethylmethacrylate to the surrounding tissues..Radiation-related adverse reactions were observed in patients treated with PVP and radiation. Conclusion PVP combined with radiotherapy or particle implantation stabilizes the vertebral body and inhibits tumor growth. The analgesic effect of PVP combined with 125I seed implantation is fast and safe in vertebral metastasis.

关 键 词：椎体转移瘤 椎体成形术 放射性粒子 放射治疗 CT引导 

分 类 号：R687.3[医药卫生—骨科学]