开腹配合彩超引导^125I粒子植入术治疗晚期胰腺癌16例临床分析

目的研究开腹手术配合彩超引导下放射性^125I粒子组织间植入治疗晚期胰腺癌的方法、疗效及并发症。方法回顾性分析16例晚期胰腺癌患者，于术前行放射微粒三维立体定向治疗计划系统（TPS）预定粒子数。开腹探查后，先行肿瘤穿刺活检证实为胰腺癌；直视下配合彩超引导行^125I粒子组织间植入术。取上腹正中切口，暴露胰腺肿块后，应用彩超探查肿瘤范围、大小，确定进针方向及范围，利用粒子枪植入粒子，注意保护血管、胰管和胆管。其中7例行胆肠吻合术，5例行胃空肠吻合术。术后2周行腹部X片或腹部CT扫描检查。结果术后11例疼痛完全或部分缓解，有效率80％，显效时间2-50d，中位起效时间10d。1例术后2周复查时发现2颗粒子游走到肝脏，2例出现胰瘘，3例出现胃排空障碍。结论开腹配合彩超引导^125I粒子植入术治疗晚期胰腺癌定位准确，粒子排列均匀，并发症较少，有较好的止痛效果，部分患者可提高生存质量，延长带瘤生存期。

Clinical analysis on 16 cases of advanced pancreatic cancer treated with color Doppler ultrasound-guided laparotomy for iodine^125 implantation

Objective To analyze the efficacy and complications of the treatment on advanced pancreatic cancer with color Doppler ultrasound-guided laparotomy for iodine^125 implantation. Methods Retrospectively analyzed 16 patients with advanced pancreatic cancer. The radiation particles numbers were scheduled preoperatively by three-dimensional directional line treatment planning system （TPS）. After abdominal exploration, the pancreatic cancer was confirmed by puncture biopsy. Color Doppler ultrasound-guided iodine^125 interstitial braehytherapy was operated under direct vision. Taking abdominal incision to expose the pancreatic cancer,color Doppler ultrasound was used to determine the direction and scope of the needle, and the particle gun was used to implant particles. Attention was paid to protect blood vessels, pancreatic channel and gallbladder channel. There were 7 case of and 5 cases of gastrojejunostomy. Abdominal X or CT scan was performed two weeks later. Results 11 cases with pain symptom were completely or partially relieved. The effective time was 2-50 days, with a median onset time of 10 days. Reexamine at two weeks after operation showed that 1 case had two particles wandered into liver,2 cases had pancreatic fistula,3 cases had obstacle in gastric emptying. Conclusions The treatment of color Doppler ultrasound-guided laparotomy for iodine^125 implantation on advanced pancreatic cancer has the advantages at accurate positioning, uniform particle arrangement, less complications and better analgesic effect. Some patients can have improved life quality and prolonged survival time after the treatment