CT引导经皮穿刺^125I粒子植入治疗胰头癌

目的探讨CT引导经皮穿刺^125I粒子植入治疗胰头癌的价值。方法2005年10月～2012年8月，16例胰头癌在CT引导下采用经皮经胃（10例）或经皮经肝经文氏孔（6例）穿刺胰头癌植入^125I粒子，术后1、3个月进行cT随访。结果16例^125I粒子植人全部成功，植入粒子12～38颗，平均23．5颗，放射性粒子分布良好，间距均〈1．5cm。穿刺过程中无一例并发症发生。6例出现一过性血淀粉酶升高120～195U／L（正常值为25～100U／L）），未经特殊处理2—3d后转为正常，无胰漏发生。术后发热4例，体温均〈38．0℃，未经处理第2天恢复正常。未发生胃肠道漏，经肝脏穿刺患者未出现肝功能异常，穿刺针道无肿瘤种植性转移。右上腹和腰背部疼痛缓解（术后VAS评分3～7分，平均4．5分），患者食欲增加。术后3个月患者均生存；术后1、3个月行上腹部增强扫描，3个月时肿瘤CR2例（12．5％），PR10例（62．5％），SD3例（18．8％），PD1例（6．2％）。结论对晚期胰头癌失去手术机会者，胰头癌合并有全身性疾病不能承受手术治疗者，以及不能承受化疗和体外放射治疗者，经皮穿刺^125I粒子植入为一种有效的治疗方法。

CT-guided Percutaneous Implantation of ^125I Seed for Carcinoma of Head of Pancreas

Objective To investigate the value of CT-guided percutaneous implantation of 125I seed for carcinoma of head of pancreas. Methods From October 2005 to August 2012, 125I seeds were implanted into the tumor of 16 patients with carcinoma of head of pancreas through percutaneous transgastric approach （10 patients） or the foramen of Winslow （6 patients） guided by CT. CT follow-up was conducted 1 and 3 months postoperatively. Results 12 -38 125I seeds （mean, 23.5 seeds） were implanted into the 16 patients without intraoperative and postoperative complications. The distribution of 125I seed was good （the interval pitch 〈 1.5 cm）. The blood amylase rose transiently in 6 cases （120 -195 U/L, normal value： 25 -100 U/L） and returned to normal 2 -3 days later without treatment. No pancreatic duct leakage or gastrointeratinal leakage occurred. Four patients had postoperative fever （ 〈 38.0 ℃ ） , but the temperature returned to normal on the second day. The liver function of all patients were normal. Implanted tumor metastasis did not occur in puncture tract. The pain of right upper abdomen and lower back were relieved, with postoperative VAS 3 - 7 points （mean, 4. 5 points）. The appetite of patients increased. All the patients were alive 3 months after operation. Contrast- enhanced CTscan showed2 cases of CR（12.5%）, 10 cases of PR（62.5%）,3 cases of SO（ 18.8%）and 1 case of PO（6.2%）3 months after operation. Conclusion CT-guided percutaneous implantation of 12sI seed is an effective method for patients with carcinoma of head of pancreas who missed the best time for operation, suffered from other diseases or could not endure chemotherapy and radiotherapy .