经皮肝动脉碘油化疗栓塞联合B超引导下^125I放射性粒子植入治疗巨块型肝癌

目的探讨经皮肝动脉碘油化疗栓塞（TACE）联合B超引导下125I放射性粒子植入治疗巨块型肝癌的临床疗效及安全性。方法选择2011年10月至2012年8月收治的巨块型肝癌患者共35例，17例经过TACE治疗后2~4周行CT扫描，采用计算机三维治疗计划系统（TPS）计算所需粒子数目及预计放射剂量，B超引导下行125I放射性粒子植入，术后复查CT，计算并调整放射剂量。粒子植入术后定期复查CT及AFP等指标。结果17例患者均顺利完成TACE联合B超引导下125I放射性粒子植入治疗。全部病例术后无局部感染、大出血等并发症，毒性不良反应少。术后4 d复查，血常规、肝肾功能正常。3个月后复查CT，肝内病灶完全缓解（CR）0例，部分缓解（PR）13例，稳定（SD）4例；6个月复查，肝内病灶CR 3例，PR 10例，SD 2例，疾病进展（PD）2例，其中PR、CR患者中有3例出现肺转移。随访1年，1年生存率58.82%。结论 TACE联合B超引导下125I放射性粒子植入治疗巨块型肝癌可以提高局部控制率，临床疗效确切，并发症少。

Transcatheter hepatic arterial oily chemoembolization combined with brightness mode guided125I seeds implantation for huge-type hepatoma

Objective To investigate the clinical efficacy and security of B ultrasound guided 125I seeds implantation combined with transcatheter hepatic arterial oily chemoembolization（TACE） for huge-type hepatoma. Methods Two to four weeks after TACE treatment, CT scanning was performed for 17 patients, and the number of seeds needed and the expected radiation dose were computed by treatment planning system（TPS）. After operating the B ultrasound guided 125I seeds implantation, the CT reexamination and computed radiation dose by TPS was performed again. CT and AFP regular reexamination were performed after the seed implantation. Results After 3 months, CT showed that complete remission （CR） was observed in no patients, partial remission （PR） in 13 patients and stable disease （SD） in 4 patients. After 6 months, CT showed that CR was observed in 3 patients, PR in 10 patients, SD in 2 patients and progress disease （PD） in 2 patients. Lung metastasis occurred in 3 patients among the PR and CR cases. During a one year follow-up, the one-year survival rate was 58.82%. Conclusion B ultrasound guided 125I seeds implantation combined with TACE for huge-type hepatoma can markedly improve the local control rate with good clinical effect and lower complications.