125I放射性粒子植入治疗无法手术切除的胰腺癌疗效分析

目的：探讨^125I放射粒子植入术治疗手术无法切除的胰腺癌的治疗疗效。方法：选择胰腺癌患者50例,内放射治疗组30例,肿瘤内部^125I放射粒子植入,有梗阻症状者,加行胆-肠吻合术和胃-空肠吻合术;对照组20例,均行单纯剖腹探查或胆-肠吻合术和（或）胃-空肠吻合术。观察肝肾功能和总胆红素变化、肿瘤大小变化、并发症发生情况、腹痛和背痛变化等。结果：两组患者总胆红素术后4周时均接近正常,肝功能明显改善,手术前后比较差异均有统计学意义;粒子植入组患者手术前后腹痛和腰痛明显改善。有效率100％（30／30）,完全缓解率97％;粒子植入组肿瘤直径有缩小趋势,对照组无明显变化;两组患者均无吻合口瘘、胆瘘、胰瘘、腹腔出血和腹腔感染。结论：^125I粒子植入对不可切除的胰腺癌具有确定疗效,不仅可以明显延长患者生存期,提高生活质量,而且对胰腺癌引起的疼痛有明显的缓解效果。     

放射性粒子植入治疗中晚期胰腺癌疗效分析

目的:探讨125I放射粒子植入术治疗手术无法切除的胰腺癌的疗效。方法:选择胰腺癌患者50例。内放射治疗组30例,肿瘤内部125I放射粒子植入,有梗阻症状者,加行胆-肠吻合术和胃-空肠吻合术;对照组20例,均行单纯剖腹探查或胆-肠吻合术和/或胃-空肠吻合术。观察肝肾功能、总胆红素变化;肿瘤大小变化;并发症发生情况;腹痛、背痛变化等。结果:两组患者总胆红素术后4周时均接近正常,肝功能明显改善,手术前后比较均具有统计学意义;粒子植入组患者手术前后腹痛、腰痛改善明显。有效率100%(30/30),完全缓解率97%;粒子植入组肿瘤直径有缩小趋势,对照组无明显变化;两组患者均无吻合口瘘、胆瘘、胰瘘、腹腔出血和腹腔感染。结论:125I粒子植入对不可切除的胰腺癌具有确定疗效,不仅可以明显延长患者生存期,提高生活质量,且对胰腺癌引起的疼痛有明显的缓解效果。     

开腹配合彩超引导^125I粒子植入术治疗晚期胰腺癌16例临床分析

目的研究开腹手术配合彩超引导下放射性^125I粒子组织间植入治疗晚期胰腺癌的方法、疗效及并发症。方法回顾性分析16例晚期胰腺癌患者,于术前行放射微粒三维立体定向治疗计划系统（TPS）预定粒子数。开腹探查后,先行肿瘤穿刺活检证实为胰腺癌;直视下配合彩超引导行^125I粒子组织间植入术。取上腹正中切口,暴露胰腺肿块后,应用彩超探查肿瘤范围、大小,确定进针方向及范围,利用粒子枪植入粒子,注意保护血管、胰管和胆管。其中7例行胆肠吻合术,5例行胃空肠吻合术。术后2周行腹部X片或腹部CT扫描检查。结果术后11例疼痛完全或部分缓解,有效率80％,显效时间2-50d,中位起效时间10d。1例术后2周复查时发现2颗粒子游走到肝脏,2例出现胰瘘,3例出现胃排空障碍。结论开腹配合彩超引导^125I粒子植入术治疗晚期胰腺癌定位准确,粒子排列均匀,并发症较少,有较好的止痛效果,部分患者可提高生存质量,延长带瘤生存期。     

胰、脾（051559～051566）

051559 放射性诱导p16基因胰腺癌靶向性表达的研究，051560 胰腺假性囊肿治疗方式的选择与评价，051561 复方丹参滴丸在81例中晚期胰腺癌化疗中的应用，051562 术中放射性^125I粒子植入在不可切除的胰腺癌中的应用，051563 胰腺实性假乳头状瘤的诊断和治疗。     

CT引导下125I粒子及5-Fu缓释剂植入治疗中晚期胰腺癌

目的 探讨CT引导下经皮穿刺125I粒子及5-氟尿嘧啶(5-Fu)缓释剂植入治疗中晚期胰腺癌的临床应用价值.方法 13例经证实的中晚期胰腺癌,采用放射性粒子治疗计划系统(treatment plan system,TPS)计算布源,在CT引导下将125I粒子缓释剂植入瘤灶内,并在125I粒子间间隔植入5-Fu缓释剂.术后2个月,分别对患者进行CT检查,根据肿瘤大小变化和临床症状缓解程度对疗效进行分级.结果 7例患者疼痛完全缓解,2例部分缓解,4例无效,平均术后3d-7d疼痛缓解.6个月后CT复查,完全缓解(CR)1例;部分缓解(PR)6例;无变化(NC)4例;进展(PD)2例.总有效率(CR+PR) 53.8%.术后未见胰瘘、胰腺炎、肠出血、腹腔内脓肿等严重并发症.结论 CT引导下经皮穿刺植入125I粒子及5-Fu缓释剂治疗中晚期胰腺癌创伤小,并发症少,姑息止痛效果好,是治疗中晚期胰腺癌安全,可靠,有效的方法 之一.     

术中放射性125Ⅰ粒子植入在不可切除的胰腺癌中的应用

目的研究放射性125I粒子植入治疗在不可切除的胰腺癌中的作用.方法2001年6月～2003年6月对16例经病理证实且不可切除的胰腺癌患者施行125I粒子胰腺肿瘤植入术,所有患者术前CT与MRI均显示胰腺肿块,术中所见证实.结果11例疼痛肿瘤患者中10例症状明显减轻,3例肿瘤缩小,1例肿瘤增大;4例Ⅰ期患者生存期均在20个月以上.2例出现了并发症,1例小肠梗阻,1例胰瘘.结论放射性125I粒子能控制原发性胰腺肿瘤的局部生长,镇痛效果显著,并发症较低,有望提高早期患者的生存期.     

CT引导下经皮穿刺植入放射性125I粒子治疗肺癌的临床应用

目的 探讨CT引导下经皮穿刺植入放射性125I粒子的肺癌治疗方法,观察临床疗效和不良反应.方法 于2004年6月-2005年10月,经CT引导125I粒子植入治疗肺癌32例.所有病例均行术前TPS制定治疗计划,术后质量验证.全部患者均植入0.5 mCi-1.0 mCi的放射性粒子,12-60颗.结果 植入病例全部成功,无死亡,部分出现气胸、出血,术后1周复查外周血象、1月复查CT及临床观察无毒副反应,术后定期复查CT,未出现放射损伤症状,未发现粒子脱落或游走等并发症.CR 22.58%、PR 61.29%、SD 12.9%、PD 3.2%.中位生存期大于12个月.结论 CT引导下经皮穿刺放射性125I粒子近距离照射治疗肺癌安全、有效,并且创伤小、并发症少.     

放射性^125I粒子植入治疗肺肿瘤52例

目的探讨放射性^125I粒子植入治疗肺肿瘤的方法和效果。方法2004年8月至2008年12月应用放射性^125I粒子植入治疗肺肿瘤患者52例,应用近距离照射计划系统（TPS）和实时计划相结合,确定粒子的分布、活度、数量、肿瘤匹配周边剂量（MDP）,在CT引导下经皮穿刺植入放射性^125I粒子,术后1、2、6个月分别行CT扫描观察肿瘤大小,化验血象、肝肾功能,评估生活质量（Karnofsky评分）。结果肿瘤从1个月至第6个月开始逐减缩小甚至消失,52例56处病灶51例有效,有效率91．1％,而对血象、肝肾功能影响不大,Kamofsky评分提高。结论合理分布的^125I粒子永久性植入治疗肺肿瘤,能使肿瘤明显缩小,放射损伤小,对改善临床症状、提高生活质量有效,是肺肿瘤有效的综合治疗手段之一。     

125I放射性粒子组织间植入在局部进展期胰腺癌治疗中的研究进展

胰腺癌是难治恶性肿瘤之一,其发病率及死亡率均较高,缺乏有效治疗手段,近年来我国相继开展125I放射性粒子植入治疗局部进展期胰腺癌.放射性粒子植入治疗肿瘤具有微创、并发症少、安全性高等特点,并可提高肿瘤局部控制率和患者生存质量.全文就125I放射性粒子植入治疗胰腺癌的治疗方法、安全性及临床疗效作一综述.     

开腹配合彩超引导125I粒子植入术治疗晚期胰腺癌16例临床分析

目的 研究开腹手术配合彩超引导下放射性125Ⅰ粒子组织间植入治疗晚期胰腺癌的方法、疗效及并发症.方法 回顾性分析16例晚期胰腺癌患者,于术前行放射微粒三维立体定向治疗计划系统(TPS)预定粒子数.开腹探查后,先行肿瘤穿刺活检证实为胰腺癌;直视下配合彩超引导行125Ⅰ粒子组织间植入术.取上腹正中切口,暴露胰腺肿块后,应用彩超探查肿瘤范围、大小,确定进针方向及范围,利用粒子枪植入粒子,注意保护血管、胰管和胆管.其中7例行胆肠吻合术,5例行胃空肠吻合术.术后2周行腹部X片或腹部CT扫描检查.结果 术后11例疼痛完全或部分缓解,有效率80%,显效时间2～50d,中位起效时间10d.1例术后2周复查时发现2颗粒子游走到肝脏,2例出现胰瘘,3例出现胃排空障碍.结论 开腹配合彩超引导125Ⅰ粒子植入术治疗晚期胰腺癌定位准确,粒子排列均匀,并发症较少,有较好的止痛效果,部分患者可提高生存质量,延长带瘤生存期.     

Iodine-125 implant and external beam irradiation in patients with localized pancreatic carcinoma: a comparative study to surgical resection

Twelve patients with biopsy-proven clinically localized ductal pancreatic cancers (less than 7 cm in greatest diameter) judged unsuitable for resection were treated by bypass surgery, an Iodine-125 implant (20-39 mCi), and postoperative irradiation (4000-4500 rads). The potential problems of significant bleeding, pancreatic fistula, or pancreatitis were not experienced. A local recurrence developed in one patient and two recurred in regional lymph nodes. The projected median survival of the group is 11 months with four of the 12 patients still surviving. For purposes of comparison all patients with pancreatic ductal carcinoma treated by radical resection during a similar time were evaluated. All ten have died with a median survival of six months. Twelve of 22 (55%) of the combined implanted and resected groups have developed distant metastasis. Further pursuit of intraoperative techniques of irradiation in combination with adjuvant multidrug chemotherapy seems indicated in an attempt to prolong patient survival which is now limited by hematogenous metastases.     

Surgical treatment of ductal pancreatic carcinoma

Among 587 patients with ductal pancreatic carcinoma who were examined between 1969 and 1987, 260 (44.3%) had distant metastases at the time of diagnosis. Tumour resections, mostly subtotal duodenopancreatectomies, were performed in 138 patients (23.5% of all patients, or 39.8% of all patients without distant metastases); in 91 patients the resection was for cure (R0). Operative mortality following tumour resection was 6% for all patients. The age-corrected 5-year survival rate was 2.9% for all patients and 16% where the resection was curative; of these 46% were in Stages I and II and 6% in Stage III. In non-curative resections, the median survival time was 7.2 months, which was significantly longer than the 3.4 months following bypass operation. Cure for pancreatic carcinoma can be achieved only through surgery, and a negative attitude towards surgery must be resisted.     

腔内植入125I粒子条及支架联合经动脉化疗栓塞治疗原发性肝癌合并门脉主干癌栓的疗效

目的 探讨腔内植入125I粒子条及支架联合经动脉化疗栓塞(TACE)治疗原发性肝癌合并门脉主干癌栓的疗效.方法 采用腔内植入125I粒子条及支架联合TACE治疗50例肝癌合并门脉主干癌栓患者,并进行随访.结果 腔内共植入支架53枚,每例患者平均植入125I粒子15.8枚.技术成功率为100%,无严重的并发症.50例患者共接受137次TACE治疗,平均每例患者2.7次.肝内病灶客观缓解率为34.4%.50例患者平均生存期为370.1 d,中位生存期为223.0 d,术后90、180、360 d累积生存率分别为97.5%、59.3%和38.4%.支架平均通畅期为524.2 d,中位通畅期为407.4 d,术后90、180、360 d支架累积通畅率分别为94.9%、75.2%和64.5%.结论 腔内植入125I粒子条及支架联合TACE是治疗肝癌合并门脉主干癌栓的有效手段.

Abstract：

Objective To evaluate the therapeutic effect of endovascular placement of iodine-125 seed strand and stent combined with transcatheter arterial chemoembolization (TACE) to treat hepatocellular carcinoma (HCC) with tumor thrombus in the main portal vein (MPVTT). Methods Fifty patients with HCC complicated by MPVTT were enrolled into this study. There were 46 men and 4 women with a mean age of 53.9 years. TACE was performed after the iodine-125 seed strand and self-expandable stent placement in the obstructed segment of the main portal vein (MPV). Results Technical success rate was 100% for placement of iodine-125 seed strand and stent in the target segment of MPV. No serious procedure-related complications occurred. The mean follow-up duration was 208. 5 d. The mean and median survival time was 370.1 d and 223.0 d, respectively. The 90-, 180-, 360-day cumulative survival rates were 97.5%, 59.3%, and 38.4%, respectively. The mean and median patent time of stent was 524.2 d and 407.4 d, respectively. The 90-, 180-, 360-day cumulative patency rates of stent were 94.9%, 75.2%, and 64.5%, respectively. Conclusion Endovascular placement of iodine-125 seed strand and stent combined with TACE is an effective therapy for HCC with tumor thrombus in the main portal vein.     

Stereotactic brachytherapy of low-grade cerebral glioma after tumor resection

The purpose of this study was to assess the impact of stereotactic brachytherapy (SBT) on survival time and outcome when applied after resection of low-grade glioma (LGG) of World Health Organization grade II. From January 1982 through December 2006 we treated 1024 patients who had glioma with stereotactic implantation of iodine-125 seeds and SBT in accordance with a prospective protocol. For the present analysis, we selected 95 of 277 patients with LGG, in whom SBT was applied to treat progressive (43 patients) or recurrent (52 patients) tumor after resection. At 24 months after seed implantation, the tumor response rate was 35.9%, and the tumor control rate was 97.3%. The median progression-free-survival (PFS) duration after SBT was 52.7 ± 7.1 months. Five-year and 10-year PFS probabilities were 43.4% and 10.7%, respectively. Malignant tumor transformation, the diagnosis "astrocytoma," and tumor volume >20 mL were significantly associated with reduced PFS. Tumor progression or relapse after SBT (53 of 95 patients) was treated with tumor resection, a second SBT, chemotherapy, and/or radiotherapy. The median overall survival duration (from the first diagnosis of LGG until the patient's last contact) was 245.0 ± 4.9 months. Patients still under observation after seed implantation had a median follow-up time of 156.4 ± 55.7 months. Perioperative transient morbidity was 1.1%, and the frequency of permanent morbidity caused by SBT was 3.3%. In conclusion, SBT of recurrent or progressive LGG after resection located in functionally critical brain areas has high local efficacy and comparably low morbidity. Referred to individually adopted glioma treatment concepts SBT provides a reasonably long PFS, thus improving overall survival. In selected patients, SBT can lead to delays in the application of chemotherapy and/or radiotherapy.     

Pancreatic cancer–Palliative therapy: surgery (bypass/resection)

Objective: We compare the outcome of palliative pancreaticoduodenectomy and palliative surgical bypass in patients with advanced pancreatic carcinoma in our hospital. Recent published related articles are also reviewed. Methods: A respective analysis was performed comparing the perioperative parameters and outcome of 20 patients who underwent pancreaticoduodenectomy with a gross suspected cancer residue and 30 patients who underwent a surgical bypass, all of the patients were diagnosed as in advanced stages intra-operatively. Results: The two groups were comparable with patient characteristics, including age, gender, initial symptoms and concomitant major organ diseases. Tumors are similar in size and intra-operatively diagnosed as in advanced stages in both groups. All of the patients in the resection group were microscopically proved having cancer residue. One postoperative mortality occurred in the resection group (5%), zero in the bypass group (P > 0.05). Overall complications were significantly higher in the resection group (30% vs. 0, P < 0.01), including 2 patients developed Acute Respiratory Distress Syndrome (ARDS), zero in the bypass group (P < 0.01); hemorrhage and transfusions in the resection group were much more than that in the bypass group (P < 0.05). Hospital stay after resection was significantly longer than bypass (20 vs. 12 days, P < 0.01). Hospital fee after resection was 4 times more than after bypass (median 61.500 vs. 15. 300 yuan, P < 0.01). Survival was significantly longer after resection (median 12.2 vs. 7.1 months, P < 0.01). Conclusion: Our results show that palliative resection in advanced pancreatic carcinoma lengthens the survival time of the patients, but this is paid for significantly higher complications than bypass.     

粒子植入放疗联合肝动脉化疗栓塞治疗肝癌的临床研究

目的观察局部125I粒子植入放疗联合肝动脉化疗栓塞(TACE)治疗肝细胞性肝癌疗效和患者耐受性。方法56例患者先采用TACE治疗1-3次,再行CT引导下125I粒子植入放疗。125I粒子植入12周后采用世界卫生组织标准评价疗效,采用美国国立癌症研究所毒性标准和美国放疗肿瘤组毒副反应评价标准评价急慢性肝脏毒副反应及其他毒副反应。结果56例中部分缓解18例,稳定36例,进展2例。全组中位生存时间31个月,1、3年生存率分别为88%、54%。1、3年局部控制率分别为93%、70%。1、3年远处转移率分别为9%、13%。单因素分析表明T分期、门脉癌栓、放疗前肝硬化Child-pugh分级、肿瘤数目和125I粒子空间排列对生存率有影响。多因素分析显示125I粒子空间排列、肿瘤数目和肝硬化Child-pugh分级是患者预后独立影响因素。5例发生急性肝脏毒副反应,1级2例,3级3例。9例出现1级上消化道急性损伤,其中1例出现轻度上消化道出血,8例表现为恶性、呕吐。10例出现1、2级外周血白细胞降低。2例出现放射性肝病。结论局部125I粒子植入放疗联合TACE综合治疗安全、有效,值得进一步研究。     

肝胰病灶同步切除治疗胰腺癌肝转移的安全性及对预后的影响

目的:探讨肝胰病灶同步切除治疗胰腺癌肝转移（pancreatic cancer with liver metastases,PCLM）的安全性及对预后的影响。方法:回顾性分析盛京医院2012年1月至2017年12月收治的27例行肝胰病灶同步切除的PCLM患者的临床资料,分析影响预后的相关因素。并分别通过与27例行胰腺根治手术的无肝转移胰腺癌患者及20例行姑息性旁路手术的PCLM患者比较,评估肝胰病灶同步切除的意义。结果:对27例肝胰病灶同步切除的胰腺癌肝转移患者临床特征及治疗方式进行多因素分析,可能影响预后的变量为:肝转移灶个数、γ-谷酰胺转肽酶（GGT）。接受肝胰病灶同步切除的PCLM患者的中位生存期低于单纯行胰腺切除的无肝转移胰腺癌患者［(5.3±0.5)个月vs (12.1±0.3)个月,P<0.001］,与行姑息性旁路手术的PCLM患者相比,差异无统计学意义［(5.3±0.5)个月vs (4.1±0.1)个月,P=0.932］。肝胰病灶同步切除组的手术时间、术后感染发生率多于单纯胰腺切除组,术中出血量、术后并发症总体发生率、术后住院天数,两组差异无统计学意义;肝胰病灶同步切除组的手术时间、术中出血量、术后并发症总体发生率、术后住院天数均多于姑息性旁路手术组。结论:肝胰病灶同步切除治疗PCLM可以相对安全的进行,个别患者可能从中受益,其中GGT无明显升高的孤立性PCLM患者,预后相对较好。但现阶段对预后改善有限,且并不明显优于姑息性旁路手术,不能明显提高整体生存率。     

胰腺癌:姑息性手术治疗(旁路术/切除术)

Objective:We compare the outcome of palliative pancreaticoduodenectomy and palliative surgical bypass in patients with advanced pancreatic carcinoma in our hospital. Recent published related articles are also reviewed. Methods:A respective analysis was performed comparing the perioperative parameters and outcome of 20 patients who underwent pancreaticoduodenectomy with a gross suspected cancer residue and 30 patients who underwent a surgical bypass, all of the patients were diagnosed as in advanced stages intra-operatively. Results:The two groups were comparable with patient characteristics, including age, gender, initial symptoms and concomitant major organ diseases. Tumors are similar in size and intra-operatively diagnosed as in advanced stages in both groups. All of the patients in the resection group were microscopically proved having cancer residue. One postoperative mortality occurred in the resection group (5%), zero in the bypass group (P ＞ 0.05). Overall complications were significantly higher in the resection group (30% vs. 0, P ＜ 0.01), including 2 patients developed Acute Respiratory Distress Syndrome (ARDS), zero in the bypass group (P ＜ 0.01); hemorrhage and transfusions in the resection group were much more than that in the bypass group (P ＜ 0.05). Hospital stay after resection was significantly longer than bypass (20 vs. 12 days, P ＜ 0.01). Hospital fee after resection was 4 times more than after bypass (median 61.500 vs. 15. 300 yuan, P ＜ 0.01). Survival was significantly longer after resection (median 12.2 vs. 7.1 months, P ＜ 0.01). Conclusion:Our results show that palliative resection in advanced pancreatic carcinoma lengthens the survival time of the patients, but this is paid for significantly higher complications than bypass.     

CT引导下植入125I 放射性粒子治疗胰腺癌的疗效观察*

目的:探讨CT引导下125I 放射性粒子植入治疗胰腺癌的临床疗效。方法:2004年12月至2007年10月对21例手术不能切除的晚期胰腺癌作了CT引导下植入125I 放射性粒子治疗。采用TPS（TreatmentPlanningSystem ）重建胰腺肿瘤的三维立体图像,计算出125I 粒子植入的数量和剂量分布率,在CT引导下将125I 粒子植入胰腺肿瘤内,采用125I 粒子活度为0.5-0.8mCi/ 颗,相隔1.0～1.5cm植入,避开血管和胰管等周围重要脏器。结果:2004年12月至2007年10月全组21例中,男13例,女8 例,年龄40～89岁,中位年龄67岁。肿瘤平均直径为5.9cm。治疗后随访2～25个月,平均术后2～5d 疼痛开始缓解。术后2 个月CT随访,肿瘤完全缓解（CR）2 例,部分缓解（PR）12例,无变化（NC）5 例,进展（PD）2 例。总有效率（CR+PR）为61.9％。全组中位生存期为8.7 个月,3 个月、6 个月、12个月累计生存率分别为100% 、71.4% 、28.6% ;其中Ⅱ+ Ⅲ期粒子植入术后中位生存期为11个月,6 个月、12个月累计生存率分别为91% 、55% ;Ⅳ期粒子植入术后中位生存期为6 个月,6、12个月生存率分别为50% 、0。12例患者CA19-9 升高,术后1～3 个月复查CA19-9 降低8 例,其中6 例CA19-9 水平下降超过50% 。1 例患者术后随访发现2 颗粒子迁移到肝脏内。在随访过程中未见上消化道出血,胰腺炎,胰瘘及放射性肠炎等严重并发症。结论:CT引导下植入125I 放射性粒子治疗胰腺癌,近期疗效确切,具有很好的姑息止痛疗效,能改善患者的生活质量,是一种安全、有效、并发症少的微创治疗方法。      

125I放射性粒子植入治疗乏氧肿瘤近期疗效的临床研究

目的 研究¹²⁵I放射性粒子在CT引导下植入治疗乏氧性肿瘤的近期疗效。方法 通过多普勒彩色超声仪检测实体瘤内血流信号,将2014—2016年于我科行¹²⁵I放射性粒子植入治疗22例肿瘤患者分为少血供组(乏氧组)12例和多血供组(非乏氧组)10例。经增强CT定位扫描后将影像学数据传输至三维粒子植入TPS上设计术前计划,然后行¹²⁵I粒子植入治疗。术后剂量学验证靶区剂量D90为106~128 cGy;术后1~3个月按照WHO标准评价病灶缓解情况。结果 两组术后3个月总有效率为82%;乏氧组和非乏氧组有效率(CR+PR)相近,术后1个月P=0.840,术后2个月P=0.696,术后3个月P=0.840。结论 ¹²⁵I放射性粒子植入治疗实体恶性肿瘤可以克服乏氧性肿瘤体外放疗的抗拒性并获得满意近期疗效。