CT导向下125I粒子植入治疗肝门区肝癌

目的评价CT导向下125I粒子植入治疗肝门区肝癌及淋巴结的临床价值.方法本组病例32例,其中肝门区肝细胞癌(HCC)8例,肝门区胆管癌(HC)12例,肝转移瘤6例,肝门区淋巴结转移6例.14例侵犯肝门胆管致肝内胆管扩张,22例合并肝硬化.全部病例经CT、MRI检查或病理穿刺活检证实.病灶平均直径为4.2 cm.采用TPS计算布源,在CT导向下将125I粒子植入瘤灶内,采用0.6～0.9 mCi活度的12I粒子相隔1.0～1.5 cm平面播植.结果2例死于远处转移,3例死于肝功能衰竭,全组中位生存时间10个月.2个月后CT复查,完全缓解(CR)2例;部分缓解(PR)20例;无变化(NC)5例;进展(pD)5例.总有效率(CR+PR)68.8%.2个月随访过程中发现7颗粒子在肝脏内游走,3颗粒子迁徙至肺内;1例出现气胸,肺压缩在30%以下,白细胞轻度下降1例.未见大出血、胆汁瘘、肠瘘、肠出血等严重并发症.结论CT导向下放射性粒子植入治疗肝门区肿瘤及淋巴结创伤小,并发症发生率低,生活质量改善明显,近期效果好,是治疗中晚期肝门区肿瘤及淋巴结的简单、安全、有效的方法.

CT guided radioactive seed 125I implantation in treating hilar hepatic tumor and metastatic lymphnodes

Objective To investigate the clinical value of CT guided radioactive seed ~(125)I implantation in treating hilar hepatic tumor and metastatic lymphnodes. Methods 32 patients with pancreatic cancer accepted CT guided radioactive seeds ~(125)I implantation were enrolled in this study.The average tumor dimension was 4.2 cm.In this series,there were 8 cases of hepatocellular carcinoma,12 cases of hilar cholangio carcinoma,6 cases of hepatic metastasis and 6 of hepatic hilar tumor and metastatic lymphnodes.Among these patients,14 cases had cholangiectasis and 22 cases had cirrhosis.Under CT guidance,~(125)I seeds of 0.6-0.9 mCi were implanted into the pancreatic cancer at a distance of 1.0-1.5 cm according to TPS. Results Two cases died on account of metastasis and three died through liver function failure.Among CT followed-up of 32 patients in 2 months,2 obtained CR,20 obtained PR,5 NC and 5 PD.The responsive rate was 68.8%.The side effects occurred during the procedure including pneumothorax in 1 case with lung compression less than 30%;7 seeds migration in liver and 3 seeds in lung.WBC decreased slightly in 1 cases during 2 months follow up.No massive bleeding,biliary fistula,intestinal fistula,intestinal hemorrhage,acute pancreatitis,enterorrhagia and intra-abdominal abscess were encountered. Conclusions CT guided radioactive seed ~(125)I implantation procedure is a safe and effective method in treating hilar hepatic tumor and metastatic lymphnodes with good clinical effects of minimal damage and few complications.