放射性^125Ⅰ粒子胃管治疗晚期食管癌10例临床分析  

Clinical analysis of 10 cases of advanced esophageal carcinoma treated with radioactive gastric tube of ^125I seeds

作　　者：孙文 牛洪欣[3] 张西坤[3] 王斌[3] 杨焕刚[3] 仲锋[3] 孙琳[3] 汪建[3] 郝亮[3] 宋文韬 

机构地区：[1]济南大学山东省医学科学院医学与生命科学学院,250200 [2]山东省医学科学院附属医院微创外科 [3]山东省医学科学院附属医院微创外科,济南250031

出　　处：《中华放射医学与防护杂志》2017年第10期752-757,共6页Chinese Journal of Radiological Medicine and Protection

基　　金：山东省科技发展计划项目（2014GSF118182）本研究得到中国北方放射性粒子多中心协作组（CNRBG）专家组的指导,特此感谢

摘　　要：目的 探讨放射性^125Ⅰ粒子胃管治疗晚期食管癌的可行性、安全性及初步疗效.方法 选择10例晚期食管癌患者,根据术前CT影像,在治疗计划系统中勾画肿瘤靶区,处方剂量60 Gy,粒子放射性活度2.22×10^7 Bq,估算出125Ⅰ粒子数,选择合适的胃管,根据肿瘤位置于胃管外周按一定的规律固定上125Ⅰ粒子,制成粒子胃管.在C臂X射线透视下将其置入到患者食管内肿瘤部位,并随访.结果 10例患者125Ⅰ粒子胃管均顺利置入,未出现食管穿孔、出血等并发症,且术后均未出现胸痛、出血、肺炎等相关并发症.术后1个月所有患者的吞咽困难,Stooler分级评分均为2-3级,其中1例在术后3个月死于其他基础疾病,6例在术后4个月时吞咽困难,Stooler分级评分达到0-1级,3例达到1-2级.结论 放射性125Ⅰ粒子胃管既能提供鼻饲,解决营养问题,又能腔内照射肿瘤,抑制肿瘤生长,临床使用是安全、可行的,可作为晚期食管癌患者的一种姑息性治疗手段.Objective To explore the feasibility, safety and preliminary efficacy of radioactive gastric tube of 125Ⅰ seeds in the treatment of advanced esophageal carcinoma. Methods For 10 cases with advanced esophageal carcinoma, the tumor target area was outlined in the TPS system according to preoperative CT images. Prescription dose was 60 Gy with 125Ⅰ seed radioactivity of 2. 22 × 10^7 Bq. Accordingly, the 125Ⅰ seeds number and the appropriate gastric tube was decided. Then, depending on the location of the tumor and certain rules, 125Ⅰ seeds were fixed in the tube wall to make the radioactive 125Ⅰ seeds gastric tube. Under the C-arm X-ray fluoroscopy, the radioactive 125Ⅰ seeds gastric tubes were placed into esophageal carcinoma site of the patients. Results The radioactive 125Ⅰ seeds gastric tubes of 10 patients were successfully placed, without esophageal perforation, bleeding complications and so on. In one month after operation, all patients with dysphagia′s Stooler classification score were 2 -3 level,of which one case died of other basic diseases in three months after operation, and six cases achieved 0 -1 level while the other three cases achieved 1 -2 level in four months after operation. There were no cases of postoperative chest pain, bleeding, pneumonia and other related complications. Conclusions The radioactive 125Ⅰ seeds gastric tube could not only help to solve nutrition problems, but also the intracavitary brachytherapy inhibit the growth of tumor, which is safe and feasible in clinical use. It can be used as a palliative treatment for patients with advanced esophageal carcinoma.

关 键 词：食管癌 ^125Ⅰ粒子 胃管 腔内照射 

分 类 号：R730.55[医药卫生—肿瘤] R735.1[医药卫生—临床医学]