125I放射粒子在肿瘤介入治疗中的应用

目的 探索采用介入微刨技术进行放射粒子病灶内植入的可行性、安全性及疗效；比较不同影像设备在粒子植入术中的作用及优缺点。方法 入选30例患者，其中15例为晚期肿瘤转移患者，15例为失去手术机会的食管癌患者。粒子植入方法：在B超或CT定位下行经皮穿刺病灶内粒子植入术；在DSA监视下将捆绑有放射粒子的食管支架植入到食管病变部位。结果 在B超、CT及DSA监视下，除因操作原因造成食管内照射支架上丢失一颗放射粒子外，所有放射粒子均准确植入到位。术后随访，患者临床症状均有明显改善；未发现局部皮肤坏死、出血、感染、放射性肺炎、食管穿孔等与粒子照射相关的并发症；手术前后连续血象、免疫指标复查未发现显著性变化。ECT复查：放射源未发现泄漏。病灶复查：15例食管癌患者1个月后胸部CT复查示13例病变厚度和体积较术前有所缩小，2例病变增大，3例随访近13个月，CT复查病变厚度较术前明显变薄；5例直接置入无膜内照射支架患者中3例术后3个月胃镜复查并活检提示支架捆绑粒子部位肿瘤明显退缩，未发现肿瘤细胞生长。15例经皮穿刺植入粒子的患者在术后2个月病变明显缩小。结论 采用介入微创技术进行放射粒子病灶内植入是可行的、安全的，疗效是明确的。

Tumor interventional therapy using 125 I seed

Objective To explore the feasibility,safety,and effect of interventional technology for inserting()~(125)I seeds into tumor focus and to study the advantage or shortcome of different image equipments used in seed implantation. Methods Fifteen cases of advanced stage tumor with metastasis and another 15 cases of advanced unresectable esophageal cancer were enrolled.Method of seed implantation was carried out by inserting()~(125)I seeds into tumor foci throngh percutaneous puncture under ultrasound or CT guidance,and placed the esophageal stent binding with()~(125)I seed to the diseased esophageal segment under DSA. Results All()~(125)I seeds were successfully released to the target places under ultrasound,CT and DSA guidance,except one seed was found to be lost from one esophageal()~(125)I seed irradiated stent due to misoperation.A follow-up showed obvious improvement of clinical symptom,no significant changes of hemogram,immunity markers,and no complications including esophageal perforation,hemorrhage,and skin necrosis.No radiation seeds shedded during the releasing processes by ECT.One month follow-up by CT showed the target places were thinned in 13 cases,thickened in 2 cases.3 cases had been followed-up for 13 months,CT revealed the obvious thinning of the foci. Three-month follow up with gastroendoscopy and biopsy demonstrated that the foci within the()~(125)I seede binding stent placement segment resolved markedly,with no tumor cells found in biopsy for 3 of 5 cases.15 cases by percutaneous puncture implantation had been followed-up for two months,showed the foci becoming obviously small urder diagnostic imaging. Conclusions It is feasible and safe to insert()~(125)I seeds into tumor foci by interventional technology and the confirmed effect is favorable.