摘要
目的:评价CT导引125I粒子植入联合经皮肝穿刺胆管内支架置入治疗胰头癌的的临床价值。方法:CT导引下125I粒子植入联合经皮肝穿刺胆管内支架置入治疗胰头癌21例,年龄39～76岁,中位年龄(59±14)岁,病灶平均直径5.2(2.2～8.3)cm。均有黄疸,均失去手术指征。经皮肝穿刺胆管内支架置入后2周左右,采用计算机立体定位计划系统(TPS)计算布源,在CT导向下将125I粒子植入胰腺瘤灶内,采用(2.2～3.3)×107GB9活度的125I例粒子相隔1.0～1.5cm平面播植。结果:黄疸明显消退18例,不明显3例,血清总胆红素由术前的(409.56±112.38)μmol/L降为2周的(106.45±87.32)μmol/L。腹痛13例中,5例疼痛完全缓解,6例部分缓解,2例无效,平均4～9d疼痛缓解。125I粒子植入后2个月CT复查,CR5例,PR9例,NC5例,PD2例,总有效率(CR+PR)66.7%。4例死于局部PD,2例死于远处转移,全组中位生存时间11个月。疗后2个月4粒粒子(3例)迁徙至肝脏内,白细胞轻度下降1例,未见胰瘘、胰腺炎、肠出血、腹腔内脓肿等严重并发证。结论:CT导引下放射性粒子植入联合胆管内支架置入治疗中晚期胰头癌创伤小,并发症发生率低,是一种有效的姑息治疗方法。
Objectice：To investigate the clinical value of CT guided radioactiveseed ^125I implantation combined with percutaneous transhepatic insertion of biliary stent intreatment of pancreatic cancer. Methods.Twenty-one patients with pancreatic cancer 5.2 cm in size on average, 13 males and 8 females, aged（59 ± 14）years （39 - 76y）, underwent CT guided radioactive seed ^125I implantation combined with percutaneous transhepatic insertion of biliary stent from June 2004 to May2006. All the patients had jaundice and 13 cases had the symptom of severer abdominal pain. All the cases were diagnosed by CT,MRI, biopsy or pathology, and these patients are all misfit to surgery. First, these patients were treated by percutaneous transhepatic insertion of biliary stent, and jaundice was relived 2 weeks-after operation, then treatment plan system was used to design the distribution of the seed ^125I needed. Under CT guidance, the ^125I seeds of （2.2 - 3.3） GB9 were implanted into the pancreatic cancer at a distance of 1.0 - 1.5 cm. ^125I seed can kill cancer cell within 1.7 cm. Results： Jaundice was relived sharply in 18 cases, not sharply in 3 cases, and the serum total bilirabin was reduced from （409.56 ± 112.38） μmol L bleore operation to （106.454 - 87.32） μmol L, 2 weeks after operation. Complete relief （CR） of pain was scan in 5 patients, partial relief （PR） in 6 patients, and no change（NC） in 2 cases. The abdominal pain was relieved 4- 9 days after the implantation. CT perfomed 2 months after implantation showcd CR in 5 cases, PR in 9 cases, NC in 5 cases, and progression in 2 cases with an overall effective rate of 66.7%. Four patients died of local progression and 2 patients died of distant metastasis. Migration of the 5 seeds into the liver was seen in 3 patients and slight decrease of white blood cells was seen in 1 patient. A follow-up for 3 - 17 months was conducted, including one case has survived for 17 months until now. No severe complications, such as pancreatic leakage, acute p
出处
《中国现代普通外科进展》
CAS
2007年第2期160-163,共4页
Chinese Journal of Current Advances in General Surgery
关键词
胰腺肿瘤
放射疗法
计算机辅助
碘放射性同位素
经皮肝穿刺胆管内支架置入术
Pancreatic neoplasms,Radiotherapy,computer-assisted,Iodine radioisotopes,Percutaneous transhepatic insertion of biliary stent
