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目的探讨超声引导下术中放射性125I粒子组织间种植治疗无法切除胰腺癌的可行性和疗效。方法2002年4月~2005年2月,我院行开腹125I粒子植入治疗晚期胰腺癌21例。术前根据治疗计划,确定粒子活度和种植粒子个数,肿瘤匹配周边剂量为65~110 Gy,每颗粒子活度为0.4~0.5 mC i。超声引导下插入粒子种植针,M ick粒子植入器植入125I粒子,粒子植入数10~75颗。8例粒子植入前或后行胃肠或胆肠吻合术。2例术后行外放疗联合单药吉西他滨化疗。1例术前置入支架,1例术后置入支架。结果15例腹痛中,14例术后1~3 d疼痛即开始缓解,其中7例疼痛完全缓解,7例部分缓解,1例无效,有效率93.3%(14/15);除2例失访外,CR 5例,PR 7例,PD 5例,NC 2例。19例中位生存期5个月,1年生存率26.3%。1例出现乳糜漏,3例粒子移位到肝脏。无胰漏和胰腺炎等并发症。结论放射性125I粒子组织间种植治疗胰腺癌具有安全、有效、创伤小和并发症发生率低等优点,是一种较好的补救治疗手段。
Objective To investigate the feasibility and efficacy of ultrasound-guided intraoperative 125I seeds interstitial implantation in the treatment of unresectable pancreatic cancer. Methods From April 2002 to February 2005, 21 patients with advanced pancreatic cancer underwent open 125I seed implantation in our hospital. Preoperative according to the treatment plan to determine the particle activity and the number of particles planted, tumor matching peripheral dose of 65 ~ 110 Gy, particle activity per particle 0.4 ~ 0.5 mCi. Ultrasound-guided insertion of particle implantation needle, Mick particle implants implanted 125I particles, the number of particles implanted 10 to 75. Eight patients underwent gastrointestinal or cholangioenterostomy before or after implantation. Two patients underwent external beam radiotherapy combined with single-agent gemcitabine chemotherapy. One patient was placed in the stent before surgery and one patient was placed in the stent. Results Among the 15 cases of abdominal pain, 14 cases started to relieve pain 1-3 days after operation. Pain relief was relieved in 7 cases, partial relief in 7 cases, ineffectiveness in 1 case, and efficiency in 93.3% (14/15) In addition, CR 5 cases, PR 7 cases, PD 5 cases, NC 2 cases. 19 cases of median survival of 5 months, 1-year survival rate of 26.3%. One patient had chylous leakage and three patients had translocation to the liver. No complications such as pancreatic leakage and pancreatitis. Conclusion Radioactive 125I seed tissue implantation of pancreatic cancer is safe, effective, small trauma and low incidence of complications, is a good remedy.