术中125I放射性粒子植入治疗胰腺癌18例

 目的　探讨125I放射性粒子术中植入近距离照射治疗中晚期胰腺癌的价值。方法　2003年5月至2007年6月行手术治疗胰腺癌75例，其中行肿瘤切除31例（A组），胆肠吻合伴或不伴胃肠吻合结合125I放射性粒子术中植入18例（B组），单纯胆肠吻合伴或不伴胃肠吻合26例（C组）。结果　全组67例获得随访，A、B、C组中位生存时间分别为19、12、7个月；术中125I放射性粒子植入近距离照射对术前疼痛的患者止痛有效率为80 %，肿瘤治疗有效率为59 %。对B组的患者经术后CT检查验证，粒子丢失率为2.6 ％，与术前治疗计划系统制定的粒子空间分布符合率为56 %。结论　积极行手术切除肿瘤是胰腺癌患者获得长期生存的重要途径，胆肠吻合伴或不伴胃肠吻合结合125I放射性粒子术中植入近距离放射治疗对中晚期胰腺癌有一定疗效，如何做到术中采集图像，实时制定治疗计划来实现治疗适形性仍需进一步探讨。

Intraoperative iodine-125 seed implantation for pancreatic carcinoma

Objective To investigate the clinical value of intraoperative iodine-125 seed implanttation in treating pancreatic carcinoma. Methods Seventy-five patients (fourty-one men, thirty-four women;median age 54 years) with pancreatic adenocarcinoma were enrolled into the study. Thirty-one patients (group A) were accepted tumor resection,eighteen patients(group B) were implanted radioactive iodine-125 seeds into the tumors by a combination of bypass surgery, twenty-six patients(group C) were treated by bypass surgery.Results Sixty-seven patients were followed up. The median survival time was 19, 12 and 7 months in group A,B,C respectively, among which the difference was significant (P ＜ 0.05). The response rate(CR+PR) was 50 % and the effective rate of pain relieving was 80% in the group B. The 97.4 % of accordance rate of seed number was demonstrated by CT film, but the accordance rate of seed space distribution was only 56 %.Conclusion At present, the active resection of the pancreatic carcinoma, including the superior mesenteric vein and the retropancreatic fusion fascia, is essential for a curative resection. The combination of Intraoperative iodine-125 brachytherapy and bypass surgery is safe and effective for pancreatic carcinoma.The seed space distribution completed by seed computer therapeutic plan needs further study.