切换至 "中华医学电子期刊资源库"
高级检索
中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2019, Vol. 16 ›› Issue (02) : 142 -146. doi: 10.3877/cma.j.issn.1672-6448.2019.02.012

所属专题： 文献；

介入超声影像学

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
杜思韵1, 付平1, 盖保东2, 杨冬艳1,†()   
  1. 1. 130031　长春，吉林大学中日联谊医院超声科
    2. 130031　长春，吉林大学中日联谊医院胃肠结直肠肛门外科
  • 收稿日期:2017-10-28 出版日期:2019-02-01
  • 通信作者: 杨冬艳

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

Siyun Du1, Ping Fu1, Baodong Gai2, Dongyan Yang1,†()   

  1. 1. Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun 130031, China
    2. Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun 130031, China
  • Received:2017-10-28 Published:2019-02-01
  • Corresponding author: Dongyan Yang
  • About author:
    Corresponding author: Yang Dongyan, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

杜思韵, 付平, 盖保东, 杨冬艳. 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[J]. 中华医学超声杂志（电子版）, 2019, 16(02): 142-146.

Siyun Du, Ping Fu, Baodong Gai, Dongyan Yang. Ultrasound-guided interstitial implantation of iodine-125 seeds for treatment of malignant abdominal tumors[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(02): 142-146.

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
1
Chen K, Xia Y, Wang H, et al. Adjuvant iodine-125 brachytherapy for hepatocellular carcinoma after complete hepatectomy: a randomized controlled trial [J]. PloS One, 2013, 8(2):e57397.
2
Liu K, Ji B, Zhang W, et al. Comparison of iodine-125 seed implantation and pancreaticoduodenectomy in the treatment of pancreatic cancer [J]. Int J Med Sci, 2014, 11(9):893.
3
Robert A, Doralina L, Costantino B, et al. NCCN clinical practice guidelines in Oncology: Adult Cancer Pain, Version 2. 2016 [J]. J Natl Compr Canc Netw, 2016.

URL    
4
Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumors: revised RECIST guideline (version 1.1) [J]. Eur J Cancer, 2009, 45(2):2495-2501.
5
Tung-Ping Poon R, Fan ST, Wong J. Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma [J]. Ann Surg, 2000, 232(1):10-24.
6
Zheng L, Lv X, Shi Y, et al. 125I interstitial brachytherapy for the treatment of myoepithelial carcinoma of the oral and maxillofacial region [J]. Brachytherapy, 2016, 15(2):240-245.
7
Yang M, Fang Z, Yan Z, et al. Transarterial chemoembolisation (TACE) combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone: a two-arm, randomised clinical trial [J]. J Cancer Res Clin Oncol, 2014, 140(4):211-219.
8
郑孝文，赵永福，唐哲等. 超声引导下肝恶性肿瘤射频消融治疗的疗效及其影响因素 [J].中华肝脏病杂志, 2016, 24(1):69-73.
9
杨伟萍，姚波，韦长元, 等. 超声引导下125I放射性粒子植入治疗原发性肝癌的临床观察[J]. 中华肿瘤防治杂志, 2012, 19(12):928-930.
10
谢正强，张丽，殷娟, 等. 超声引导下125I粒子植入治疗中晚期肝癌 [J]. 现代肿瘤医学, 2011, 19(2):314-315.
11
刘洋，盛波，姜凯, 等. 术中放射性粒子植入治疗晚期胰腺癌的疗效 [J]. 中华肝胆外科杂志, 2014, 20(6):446-448.
12
Han Q, Deng M, Lv Y, et al. Survival of patients with advanced pancreatic cancer after iodine125 seeds implantation brachytherapy: A meta-analysis [J]. Medicine (Baltimore), 2017, 96(5):e5719.
13
李玲，郎景和，樊庆泊, 等. 原发性腹膜后肿瘤的研究进展 [J]. 中华妇产科杂志, 2015, 50(1):76-78.
14
Patel MI, Motzer RJ, Sheinfeld J. Management of recurrence and follow-up strategies for patients with seminoma and selected high-risk groups [J]. Urol Clin North Am, 2003, 30(4):803-817.
15
Hirasaki S, Moriwaki T, Tsuzuki T, et al. Extragonadal retroperitoneal embryonal carcinoma successfully treated with chemotherapy [J]. Intern Med, 2003, 42(11):1122-1126.
16
李留峥，于杰，左峻林, 等. 复发性腹膜后肿瘤综合治疗26例体会 [J]. 临床肿瘤学杂志, 2006, 11(6):448-449, 454.
17
徐少明. 复发性腹膜后肿瘤的综合治疗 [J]. 中国实用外科杂志, 2002, 22(8):463-464.
18
Yang B, Guo W, Lan T, et al. CT-guided 125I seed implantation for inoperable retroperitoneal sarcoma: A technique for delivery of local tumor brachytherapy [J]. Exp Ther Med, 2016, 12(6):3843-3850.
19
Wang Z. CT-guided radioactive 125I seed implantation therapy of symptomatic retroperitoneal lymph node metastases [J]. Cardiovasc Intervent Radiol, 2014, 37(1):125-31.
20
Yao L, Jiang Y, Jiang P, et al. CT-guided permanent 125I seed interstitial brachytherapy for recurrent retroperitoneal lymph node metastases after external beam radiotherapy [J]. Brachytherapy, 2015, 14(5):662-669.
21
徐静，梅铭惠，陈谦, 等. 术中组织间植入125I粒子治疗肝恶性肿瘤 [J]. 中华实验外科杂志, 2005, 22(3):368-369.
22
李勇，冯贤松. 125I粒子术中植入治疗腹腔恶性肿瘤 [J]. 腹部外科, 2005, 18(2):96-97.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 张璇, 马宇童, 苗玉倩, 张云, 吴士文, 党晓楚, 陈颖颖, 钟兆明, 王雪娟, 胡淼, 孙岩峰, 马秀珠, 吕发勤, 寇海燕. 超声对Duchenne肌营养不良儿童膈肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1068-1073.
[3] 朱连华, 费翔, 韩鹏, 姜波, 李楠, 罗渝昆. 高帧频超声造影在胆囊息肉样病变中的鉴别诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 904-910.
[4] 张梅芳, 谭莹, 朱巧珍, 温昕, 袁鹰, 秦越, 郭洪波, 侯伶秀, 黄文兰, 彭桂艳, 李胜利. 早孕期胎儿头臀长正中矢状切面超声图像的人工智能质控研究[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 945-950.
[5] 陈舜, 薛恩生, 叶琴. PDCA在持续改进超声危急值管理制度中的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(09): 974-978.
[6] 周钰菡, 肖欢, 唐毅, 杨春江, 周娟, 朱丽容, 徐娟, 牟芳婷. 超声对儿童髋关节暂时性滑膜炎的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 795-800.
[7] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[8] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 844-848.
[9] 张丽丽, 陈莉, 余美琴, 聂小艳, 王婧玲, 刘婷. PDCA循环法在超声浅表器官亚专科建设中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 717-721.
[10] 罗刚, 泮思林, 陈涛涛, 许茜, 纪志娴, 王思宝, 孙玲玉. 超声心动图在胎儿心脏介入治疗室间隔完整的肺动脉闭锁中的应用[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 605-609.
[11] 黄佳, 石华, 张玉国, 胡佳琪, 陈茜. 胎儿左头臂静脉正常与异常超声图像特征及其临床意义[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 610-617.
[12] 袁泽, 庄丽. 超声检测胎儿脐动脉和大脑中动脉血流对胎儿宫内窘迫的诊断价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 618-621.
[13] 蒋佳纯, 王晓冰, 陈培荣, 许世豪. 血清学指标联合常规超声及超声造影评分诊断原发性干燥综合征的临床价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 622-630.
[14] 武壮壮, 张晓娟, 史泽洪, 史瑶, 原韶玲. 超声联合乳腺X线摄影及PR、Her-2预测高级别与中低级别乳腺导管原位癌的价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 631-635.
[15] 孔博, 张璟, 吕珂. 超声技术在复杂腹壁疝诊治中的作用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 670-673.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号