B型超声引导^(125)I 粒子植入治疗溶骨性骨转移瘤18例  

Ultrasound-guided percutaneous ^(125)I seed implantation for the treatment of osteolytic metastases:clinical analysis of 18 cases

作　　者：江旭[1] 颜红菊[1] 陈文会[1] 李慧[1] 刘敬禹[1] 王卫星[1] 杨聚鹏 杨继金[1] 

机构地区：[1]第二军医大学长海医院介入科,上海200433 [2]长春一汽总医院普外科

出　　处：《介入放射学杂志》2015年第4期346-349,共4页Journal of Interventional Radiology

摘　　要：目的观察B型超声(B超)引导下经皮穿刺125I粒子植入姑息性治疗溶骨性骨转移瘤的疗效。方法对2011年2月至2013年12月收治的18例晚期肿瘤患者的溶骨性骨转移瘤采用B超实时引导经皮穿刺植入125I粒子,术前、术后3 d以及术后1个月根据视觉模拟评分法(VAS)对疼痛评分。所有治疗病灶术后1个月复查CT检测肿瘤大小变化,观察粒子分布情况,必要时重复治疗。根据CT结果,按实体瘤的疗效评价标准(RECIST)评价疗效。结果 18例患者进行33次手术,术后3 d局部疼痛较术前已有明显改善,与术前VAS比较P=0.000,差异有统计学意义。术后1个月疼痛仍能较好控制,P=0.000,差异有显著统计学意义。末次手术后1个月与基线相比观察疗效:CR 0例(0%),PR 11例(61.1%),SD 6例(33.3%),PD 1例(5.6%),局部控制率(CR+PR)61.1%。无严重的放疗并发症。结论 B超引导简便,可重复性好,能安全、有效地引导经皮穿刺125I粒子植入近距离放射治疗溶骨性骨转移瘤,在不采用治疗计划系统(TPS)的情况下,也能获得较好的局部控制率,疼痛缓解显著。Objective To assess the effect of ultrasound- guided percutaneous125 I seed implantation for the treatment of osteolytic metastases. Methods From February 2011 to December 2013, a total of 18 patients with advanced cancer complicated by osteolytic metastases received ultrasound- guided percutaneous implantation of125 I seeds. According to visual analog score（VAS） the pain was estimated before and 3 days as well as one month after the treatment. One month after the treatment follow- up CT scan was performed in all patients to check the tumor size and the distribution of125 I seeds, and the therapy was repeated if necessary.The efficacy was evaluated according to Response Evaluation Criteria in Solid Tumors（RECIST）. Results A total of 33 times of procedure were carried out in the 18 patients. Three days after the treatment, local pain was obviously relieved in all cases. Compared with preoperative VAS, the postoperative VAS was significantly improved（P =0.000）. The pain was well controlled even one month after the treatment（P =0.000）. One month after the last treatment the complete remission（CR） rate was 0%（n=0）, partial remission（PR） rate61.1%（n=11）, stable disease（SD） 33.3%（n=6） and progress disease（PD） 5.6%（n=1）, and local control rate（CR＋PR） was 61.1%. No severe brachytheray- related complications occurred. Conclusion Ultrasoundguided percutaneous125 I seed implantation brachytherapy is technically simple and repeatable, it can safely and effectively guide the performance of percutaneous125 I seed implantation for the treatment of osteolytic metastases. Even in the circumstance of not using TPS, this technique can also obtain satisfactory local control rate and significant pain relief.

关 键 词：超声 骨转移 ^125I粒子 近距离放射治疗 

分 类 号：R738.1[医药卫生—肿瘤] R445.1[医药卫生—临床医学] R730.55