CT引导下经皮化学消融术治疗腹部淋巴结转移性病变

目的 探讨CT引导下经皮化学消融术治疗腹部淋巴结转移性病变的可行性和治疗效果。方法对15例腹部癌性淋巴结转移患者进行CT引导下经皮穿刺化学消融术。用20～23G Chiba针或21G多孔酒精注射针于局醉下分步穿入肿大的淋巴结内，注射超液化碘化油2～4ml加盐酸阿霉素30～50mg、卡铂200mg或健择400～600mg混合乳剂，尽量使之充满全部肿大淋巴结。术后随访1～13个月。结果无1例出现术中和术后并发症。患者疼痛缓解率100％，消失率20％。86．7％治疗部位淋巴结变小。结论CT引导下经皮化学消融术是治疗腹部癌性淋巴结转移的微创新方法，可减轻或消除疼痛、控制或减缓局部病变的发展。

CT guided percutaneous lymphatic chemoablation for treatment of intra-abdominal metastatic lymph nodes

Objective To explore the feasibility and efficacy of CT guided percutaneous lymphatic chemoablation of intra-abdominal metastatic lymph nodes. Methods Fifteen cases of intra-abdominal cancerous metastastic lymph nodes, 8 males and 7 females, aged from 38 to 72 years, underwent percutaneous lymphatic chemoablation under the guidance of spiral CT. Patients took prone position or decubitus position, CT scan were performed to confirm the lesion position, puncture point, distance and the angle of puncture, and the puncturing pathway avoiding injury of nerves, important blood vessels and empty internal organs. After focal anesthesia with 2% lidocaine, 20-22 G Chiba needles or 21 G multi-holes alcohol injection needles was punctured into the swollen lymph node according to the distance and the angle measured. Emulsion mixture of chemoablation agents (ultrafluid lipiodol 2-4 ml, adriamycin 30-50 mg, or plus carboplatin 200 mg, or plus gemzar 400-600 mg according to the size of abnormal lymph node and pathologic types of the primary tumor) was gradually injected into the lymphtic nodes, until the nodes were almost fully filled by the emulsion mixture under CT scanning supervision. The patients were followed up for 1 to 13 months. Results Pain alleviating rate was 100%, in 20% of which pain disappeared completely. Treated lymph nodes had become smaller in 86.7% cases. No complications occured during and after operation. Conclusion CT guided percutaneous lymphatic chemoablation is an effective mininvasive method in alleviating or eliminating pains caused by intra-abdominal cancerous metastastic lymph nodes, and in controlling or slowing focal lesional development.