肝癌肝移植术后复发及肝外转移瘤的125I粒子植入治疗

目的评价CT导向下^125I粒子植入术治疗肝癌肝移植术后复发及肝外转移瘤的临床价值。方法肝癌肝移植术后复发及肝外转移瘤患者11例行^125I粒子植入术共33人次,年龄35—68岁,中位年龄56岁。所有患者病灶总数为45个,平均每人4．09个病灶,病灶平均直径为2．5cm。术前采用治疗计划系统（TPS）计算布源,术中将活度为30MBq的^125I粒子在CT导向下植入肿瘤病灶内。粒子按照0．5—1．0cm平面插植。肿瘤周边匹配剂量（MPD）100—150Gy,每个患者植入粒子数10—100颗不等。结果45个病灶,完全缓解（CR）17个;部分缓解（PR）20个;无变化（NC）7个;进展（PD）1个。总有效率为82．2％。术中1例出现气胸,肺压缩在30％以内,经保守治疗好转,手术中少量出血者3例;术后1周痰中带血,体温升高者5例。2个月随访过程中发生粒子移位2例;白细胞下降2例,程度较轻。未见大出血、胆汁瘘、胰瘘等严重并发症。结论CT导向下^125I粒子植入术治疗肝癌肝移植术后复发及转移瘤疗效确切,创伤小,并发症少。

Radioactive seed 125I implantation in treating recurrence and metastasis after liver transplantation in hepatoma

OBJECTIVE: To investigate the clinical value of CT-guided radioactive seed (125)I implantation in treating recurrence and metastasis after liver transplantation in hepatoma. METHODS: Eleven patients with recurrence and metastasis after liver transplantation for hepatoma, with 45 metastatic lesions, 2.5 cm in diameter on average totally 9 males and 2 females, aged 56 (35 approximately 68), underwent CT-guided radioactive seed 125I implantation for 33 man-times. 125I seeds of the radioactivity of 30 MBq at a distance of 0.5 approximately 1.0 cm were implanted into the recurrence and metastasis lesions according to TPS system before the operation. The matched peripheral dosage (MPD) was 100 approximately 150 Gy, and the number of radioactive seeds for one patient ranged 10 approximately 100. RESULTS: Among the 45 lesions, 17 obtained CR, 20 PR, 7 NC, and 1 PD. The response rate was 82.2%. Side effects occurred during the procedure including pneumothorax in 1 cases with the lung compressed less than 30 percent, bleeding in 3 cases, and blood in sputum and fervescence in 5 cases. Seeds migration 2 months after the operation occurred in 2 cases. WBC decreased slightly in 2 cases 2 weeks after the operation, with the WBC count >or= 3 x 10(9)/L. No other severe complications, such as massive hemorrhage, bile fistulae, and pancreatic fistula were seen. CONCLUSION: CT guided radioactive seed 125I implantation procedure has good clinical effects with minimal damage and few complications in treating recurrence and metastasis after liver transplantation in hepatoma.