经皮超声引导与开腹术中超声引导植入放射性125I粒子治疗胰腺癌的效果比较

目的：探讨经皮超声引导与开腹术中超声引导植入放射性¹²⁵I粒子治疗局部进展期胰腺癌的疗效，为临床治疗进展期胰腺癌术式的选择提供依据。方法：收集73例进展期胰腺癌患者的临床资料，包括超声引导下经皮穿刺放射性¹²⁵I粒子植入术组（A组）42例及开腹术中超声引导放射性¹²⁵I粒子植入术组（B组）31例。比较2组患者疼痛缓解情况、肿瘤局部控制情况、术后生存期及并发症发生情况。结果：A和B组患者疼痛缓解有效率为91.89%和86.40%，2组比较差异无统计学意义（P=0.815）；A和B组患者肿瘤局部控制有效率为71.43%和77.42%，2组比较差异无统计学意义（P=0.564）；A和B组患者中位生存期为11和12个月；1年生存率为36.9%和35.8%，2组比较差异无统计学意义（P=0.664）。A组患者术后7例出现发热；B组患者术后6例出现发热，2例出现小腿肌间静脉血栓，1例出现胃潴留，1例出现胆肠吻合口瘘，1例出现腹胀，1例术后早期出现肠梗阻；2组患者并发症发生率分别为16.67%和38.71%，组间比较差异有统计学意义（P=0.034）。结论：经皮超声引导放射性¹²⁵I粒子植入术治疗局部进展期胰腺癌并发症少，且与开腹术中超声引导放射性¹²⁵I粒子植入术在疼痛缓解、肿瘤局部控制和生存期方面有相同疗效。

Comparison of effects of ultrasound-guided implantation of radioative 125I particles in treatment of pancreatic cancer between percutaneous puncture and laparotomy

Objective:To discuss the clinical effects of implantation of radioative 125I seeds by the way of percutaneous puncture and laparotomy under the guidance of ultrasound in the treatment of locally advanced pancreatic cancer, and to provide the basis for choosing surgical methods in treating advanced pancreatic cancer.Methods:The clinical materials of 73 patients with advanced pancreatic cancer were collected, including 42 patients who underwent implantation of radioactive 125I seeds by percutaneous puncture(group A) and 31 patients who underwent impantation of radioactive 125I seeds by laparotomy(group B).The pain relief, local control of tumor, postoperative survival time and complications of the patients were compared between two groups. Results:The rates of pain relief of the patients in group A and group B were 91.89% and 86.40%,and there was no significant difference(P=0.815).The local control rates of the patients in group A and group B were 71.43% and 77.42% ,and there was no significant difference(P=0.564).The medium survival time of the patients in group A and group B were 11 months and 12 months;the one-year survival rates were 36.9% and 35.8%, and there was no significant difference(P=0.664).Seven patients in group A got fever;in group B, six patients got fever, two got calf muscle venous thrombosis, one got gastric retention, one got bilioentric anastomosis, one got abdominal distension and one got intestinal obstruction in the early stage after operation.The incidence rates of complications of the patients in two groups were 16.67% and 38.71%, and there was significant difference(P=0.034).Conclusion:Percutaneous implantation of radioactive 125I particles guided by ultrasound causes less complications in the treatment of locally advanced pancreatic cancer.Moreover, the percutaneous way reaches the same effect as the intraoperative way does on the pain relief, local control of tumor and survival time prolonged.