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目的分析胰腺癌超声内镜(EUS)引导下~(125)Ⅰ粒子种植术治疗晚期胰腺癌的肿瘤变化及粒子移位,并评价其治疗效果。方法对17例不能手术切除的中晚期胰腺癌患者行EUS引导下放射性~(125)Ⅰ粒子内照射治疗。所有患者治疗前均参照治疗设计系统估算期望植入粒子数量。治疗后每月复查,观察治疗前、后肿瘤变化及粒子移位、脱落等情况。结果17例患者均经EUS植入~(125)Ⅰ粒子成功。治疗前肿瘤最大长径平均值为5.4cm(3.7～9.0cm),平均植入粒子数量为27颗,平均每次植入粒子中位数为14(7～24)颗,平均植入2次。平均单颗粒子的放射性活度为(0.689±0.016)mCi。治疗后平均随访4.8个月(2～14个月)。治疗后3个月评估疗效,部分缓解5例(29.4%),疾病稳定7例(41.2%)。进展恶化5例(29.4%)。治疗后腹部平片示5例(29.4%)出现粒子丢失移位。1例脾区移位,1例肝脏移位,3例肠腔移位。治疗后粒子丢失4例。1例出现脾脏及左膈下囊肿。结论EUS引导下~(125)Ⅰ粒子内照射治疗晚期胰腺癌,可使粒子照射区域内病灶明显萎缩。但需注意放射性粒子对周围脏器的损害及粒子脱落移位等并发症的发生。
Objective To analyze the tumor changes and particle translocation of ~ (125) Ⅰ seed implantation in patients with advanced pancreatic cancer under endoscopic ultrasonography (EUS) guided by pancreatic cancer and evaluate its therapeutic effect. Methods 17 cases of unresectable patients with advanced pancreatic cancer underwent EUS-guided radioactive 125 I irradiation. All patients treated with the treatment design system before treatment to estimate the expected number of implanted particles. After treatment monthly review, observation of tumor changes before and after treatment and particle displacement, shedding and so on. Results All the 17 patients were successfully injected with 125I particles through EUS. The average maximum diameter of the tumor before treatment was 5.4cm (3.7 ~ 9.0cm), the average number of implanted particles was 27, the average number of particles per implantation was 14 (7 ~ 24), with an average of 2 implants . The average radioactivity of single particles was (0.689 ± 0.016) mCi. After treatment, the average follow-up of 4.8 months (2 to 14 months). Three months after treatment, the curative effect was evaluated. Five patients (29.4%) were partially relieved and seven patients (41.2%) were stable. Progress worsened in 5 cases (29.4%). Five cases (29.4%) of abdominal plain film showed the loss of particles after treatment. One case of spleen displacement, one case of liver displacement, three cases of intestinal displacement. Four cases of particle loss after treatment. One case appeared spleen and left subphrenic cyst. Conclusion EUS-guided internal irradiation of 125I particles in advanced pancreatic cancer can significantly ameliorate the lesions in the irradiated area. However, attention should be paid to radioactive particles on the surrounding organs damage and particle shedding and other complications.