CT引导下125I粒子植入治疗腹膜后淋巴结转移癌临床应用分析

目的 探讨在CT引导下经皮穿刺植入放射性125I粒子治疗有症状的腹膜后淋巴结转移患者的临床疗效。 方法 于2015年4月—2019年1月对在中国科技大学第一附属医院诊治的35例病理证实的恶性肿瘤伴腹膜后淋巴结转移的患者，采用CT引导下植入放射性125I粒子的方法进行治疗。治疗前先应用计划系统(TPS)做淋巴结的重建三维图像，然后计算125I粒子的相应数量和分布。CT引导下经皮、经肝植入粒子。评价患者1年生存率、临床获益率、客观有效率，观察并发症情况。 结果 患者随访期为5～18个月，平均时间为7个月。难治性疼痛的症状得到了显著的改善，卡氏评分明显上升。术后1、3、6、9、12个月患者生存率分别为100.00%、100.00%、71.42%、54.29%、48.57%。客观有效率分别为69.49%、79.66%、79.49%、82.39%、70.97%，临床获益率分别为89.83%、91.53%、84.62%、85.29%、77.42%。18例患者死亡。在组织间内照射治疗期间未发生粒子移位或术后骨髓抑制、大出血、感染、放射性腹膜炎、放射性肠炎、瘘等严重并发症。 结论 CT引导下125I粒子植入治疗恶性肿瘤伴腹膜后淋巴结转移的病例，在改善患者生存质量方面是可行的、安全的、有效的。 

Clinical application of CT-guided 125I seed implantation for retroperitoneal lymph node metastases

Objective To explore the clinical efficacy of CT-guided radioactive 125I seed implantation in treating retroperitoneal lymph node metastases. Methods From April 2015 to January 2019, 35 patients pathologically confirmed malignant tumor with retroperitoneal lymph node metastasis received CT-guided radioactive 125I seed implantation. Three-dimensional images of lymph nodes were reconstructed using the treatment planning system (TPS) before treatment, and the corresponding number and distribution of 125I seeds were calculated. CT-guided percutaneous and transhepatic seed implantation. The 1-year survival rate, clinical benefit rate, response rate, and the complications were evaluated. Results Patients were followed up for 5-18 months, with an average of 7 months. Symptoms of refractory pain were significantly resolved, while the Karnofsky score was significantly increased. The 1-year survival rate of 1, 3, 6, 9 and 12 months after operation was 100.00%, 100.00%, 71.42%, 54.29% and 48.57%, respectively. The response rate was 69.49%, 79.66%, 79.49%, 82.39% and 70.97%, respectively. The clinical benefit rate was 89.83%, 91.53%, 84.62%, 85.29% and 77.42%, respectively. Eighteen patients died. There were no serious complications such as particle displacement, postoperative bone marrow suppression, massive hemorrhage, infection, radioactive peritonitis, radioactive enteritis and fistula. Conclusion CT-guided 125I seed implantation for malignant tumor with retroperitoneal lymph node metastasis is feasible, safe and effective in improving patient quality of life.