CT引导下同轴法^(125)I粒子植入治疗伴癌痛腹部淋巴结转移瘤的效果分析  

The Effect Analysis of CT-guided Coaxial ^(125)I Implantation in the Treatment of Cancer Pain with Abdominal Lymph Node Metastases

作　　者：孙琼[1] 张家兴[2] 徐斌[1] 马艳艳[1] 董小庆[1] 张凯[1] 王道超 

机构地区：[1]宿迁市工人医院,江苏宿迁223800 [2]同济大学附属上海第十人民医院

出　　处：《中外医学研究》2016年第25期6-10,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:评价CT引导下同轴法^(125)I粒子植入治疗伴癌痛的腹腔及腹膜后淋巴结转移瘤的安全性及临床效果。方法:22例伴有癌痛腹腔及腹膜后淋巴结转移瘤(共33个转移灶,大小3~15 cm)患者,^(125)I粒子植入采用术前TPS计划、术中CT引导下同轴法进行,处方剂量(prescribed dose,PD)为80~100 Gy。术后即时CT检查传入TPS验证粒子植入质量,以疼痛视觉模拟评分法(VAS)分别在术后1、7、30、60、90 d 5个时间点评价患者疼痛指标的变化,随访观察临床症状、影像学(肿瘤体积)改变、相关并发症、评估肿瘤近期疗效。结果:22例患者中,术后即时TPS验证技术成功率为86.4%(19/22),即19例粒子植入质量很好,植入质量不好的3例中,1例D90<MPD,1例TVR<1,1例植入粒子剂量的不均匀度>20%PD。^(125)I粒子植入后各癌痛监测点疼痛视觉模拟评分(VAS)均较治疗前降低(P<0.01),植入后1、7、30、60、90 d癌痛有效率分别为72.73%、86.36%、90.91%、81.82%、72.73%。临床近期疗效CR 3例,PR 9例,SD 7例,PD 3例,总客观有效率(CR+PR)为54.55%,疾病获益率(CR+PR+SD)为86.36%。随访时间5~24个月(平均15.6个月),中位生存时间为12.8个月,半年和1年生存率分别为95.5%(21/22)和77.3%(17/22)。无严重并发症。结论:^(125)I放射性粒子组织间植入治疗伴癌性疼痛的腹腔及腹膜后淋巴结转移瘤起效迅速、效果持续,无不良反应,值得临床进一步推广。Objective： To evaluate the clinical effect of CT-guided coaxial method of ^125I seed implantation in patients with cancer pain in the abdominal cavity and retroperitoneal lymph node metastatic tumors and its clinical effect.Method： 22 cases with abdominal pain and retroperitoneal lymph node metastases（33 metastatic loci, size 3~15 cm）,^125I particles were implanted with preoperative TPS plan, CT guided coaxial method was performed during the operation, and the prescription dose was 80-100 Gy.lmmediately after CT examination was introduced into TPS, and to verify the quality of particle implantation.The changes of pain indicators and the short-term effect were respectively evaluated with visual analogue scale （VAS） at the 5 points of time （1, 7, 30, 60 and 90 d after treatment）. All the patients were followed up and were kept under observation for clinical symptoms, imaging （tumor volume） changes, related complications, evaluation of the recent efficacy of tumor.Result： In 22 patients, the results of real-time TPS validation： the technical success rate was 86.4%（19/22）, that is, 19 cases of particle implantation quality is very good, 3 eases of poor quality of implant, 1 case of D90〈MPD, 1 case of TVR〈1, 1 case of implanted particles dose of uneven degree 〉20%PD.Simulation of the score of each monitoring point pain pain visual ^125I particle implantation（VAS） were lower than those before treatment（P〈0.01）, after 1, 7, 30, 60, 90 d implantation pain rates were 72.73%, 86.36%, 90.91%, 81.82%, 72.73%.Clinical efficacy CR 3 cases, 9 cases ofPR, SD 7 cases, 3 cases of PD.The total objective response rate （CR＋PR） was 54.55%, disease benefit rate （CR＋PR＋SD） for 86.36%.Followed up for 5 to 24 months（average 15.6 months）, the median survival time for 12.8 months, 6 months and 1 year survival rates were 95.5%（21/22） and 77.3%（17/22）, no serious complications. Conclusion： ^125I radioactive seed interstitial implantation in treatment of cancer pain in the

关 键 词：肿瘤转移 淋巴结 腹部 CT引导 同轴法 ^125I 近距离放射疗法 

分 类 号：R735[医药卫生—肿瘤] R730.55[医药卫生—临床医学]