超声引导下经皮穿刺植入放射性<sup>125</sup>I粒子治疗腹部恶性肿瘤

doi:10.3877/cma.j.issn.1672-6448.2019.02.012

目的

探讨超声引导下经皮穿刺植入放射性¹²⁵I粒子治疗腹部恶性肿瘤的临床效果。

方法

选取2014年1月至2016年12月在吉林大学中日联谊医院诊治的142例腹部恶性肿瘤患者，其中，42例肝癌，53例胰腺癌，27例腹膜后原发肿瘤，20例腹腔转移癌。均行超声引导下放射性¹²⁵I粒子腹部肿瘤内植入术，统计术前疼痛者，判断术后缓解程度。CT对比手术前后肿瘤长径，并随访有无手术相关并发症。

结果

（1）疼痛缓解有效率：87.35%（肝癌85.71%，胰腺癌90.00%，腹膜后肿瘤85.00%，腹腔转移癌84.62%）；（2）肿瘤局部控制有效率：76.06%（肝癌83.33%，胰腺癌73.58%，腹膜后肿瘤70.37%，腹腔转移癌75.00%）；（3）并发症：15例发热、腹腔积液及腹胀各5例、2例胃潴留（一过性）。发生率：19.01%（肝癌19.05%，胰腺癌18.87%，腹膜后肿瘤18.52%，腹腔转移癌20.00%）。

结论

对于丧失手术切除机会的腹部恶性肿瘤患者而言，超声引导经皮穿刺放射性¹²⁵I粒子肿瘤内植入术可有效缓解疼痛、较好控制肿瘤的局部生长，并发症少，疗效肯定。超声作为其影像学引导手段，有实时显示、操作简便、定位准确等优势，值得推广应用。

关键词: 超声检查, 经皮穿刺, 腹部恶性肿瘤, 放射性¹²⁵I粒子, 近距离放射治疗

Objective

To assess the clinical effects of implantation of radioactive 125I seeds under the guidance of ultrasound in the treatment of abdominal cancer.

Methods

One hundred and forty-two patients with malignant abdominal tumors in Chian-Japan Union Hospital of Jilin University from January 2014 to December 2016 were selected (42 liver cancer patients, 53 pancreatic cancer patients, 27 retroperitoneal carcinoma patients, and 20 celiac carcinoma patients). The number of patients with pain before operation and the degree of pain relief after operation were recorded. The tumor long-axis diameters before and after operation were compared by CT. The complications related to the operation were recorded.

Results

The rate of pain relief was 87.35% (liver cancer, 85.71%; pancreatic cancer, 90.00%; retroperitoneal carcinoma, 85.00%; celiac carcinoma, 84.62%). The local control rate of tumors was 76.06% (liver cancer, 83.33%; pancreatic cancer, 73.58%; retroperitoneal carcinoma, 70.37%; celiac carcinoma, 75.00%). Fifteen patients developed fever after operation, five developed abdominal distension, five developed seroperitoneum, and two developed transient gastric retention. The rate of complications was 19.01% (liver cancer, 19.05%; pancreatic cancer, 18.87%; retroperitoneal carcinoma, 18.52%; celiac carcinoma, 20.00%).

Conclusion

For patients with malignant abdominal tumors who have lost the chance of resection, ultrasound-guided intratumoral implantation of radioactive ¹²⁵I seeds can relieve pain effectively and well control the local growth of tumors with few complications. Ultrasound guidance has the advantages of timely presentation, simple operation, and accurate localization.

Key words: Ultrasonography, Percutaneous puncture, Abdominal tumor, radioactive ¹²⁵I seeds, Brachytherapy

图1 胰体癌患者彩色多普勒超声图像。靶区内未显示强回声的区域为粒子植入"冷区"（箭头所示）

图2 胰体癌患者增强CT图像。图a为粒子植入术前示肿瘤大小约3.5 cm×2.1 cm（箭头所示）；图b为粒子植入术后3个月原肿瘤区未见肿物，粒子呈堆状聚集

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Ultrasound-guided interstitial implantation of iodine-125 seeds for treatment of malignant abdominal tumors

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Ultrasound-guided interstitial implantation of iodine-125 seeds for treatment of malignant abdominal tumors