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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125I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。
Objective To evaluate the clinical value of CT guided 125I seed implantation in the treatment of hepatic cancers and lymph nodes in hilar region. Methods 32 cases of this group of patients, including hilar hepatocellular carcinoma (HCC) in 8 cases, hilar cholangiocarcinoma (HC) in 12 cases, 6 cases of liver metastases, hilar lymphatic metastasis in 6 cases. 14 cases of hilar bile duct invasion caused by intrahepatic bile duct dilatation, 22 cases with cirrhosis. All cases confirmed by CT, MRI or pathological biopsy. The average diameter of the lesions was 4.2 cm. The cloth source was calculated by TPS. 125I seeds were implanted into the tumor lesion under the guidance of CT, and 125I seeds with the activity of 0.6 ~ 0.9 mCi were planted in 1.0 ~ 1.5 cm intervals. Results 2 cases died of distant metastasis, 3 died of liver failure, the median survival time of 10 months. Two months after the CT review, complete remission (CR) in 2 cases; partial response (PR) in 20 cases; no change (NC) in 5 cases; progression (PD) in 5 cases. The total effective rate (CR + PR) 68.8%. During the follow-up period of 2 months, seven particles migrated within the liver and three particles migrated into the lung. One case had pneumothorax, and the pulmonary compression was less than 30% and the white blood cells slightly decreased in 1 case. No major bleeding, bile fistula, intestinal fistula, intestinal bleeding and other serious complications. Conclusion CT-guided radioactive seed implantation in the treatment of hepatic portal tumor and lymph node injury is small, the incidence of complications is low, quality of life improved significantly, the recent effect is good, is the treatment of advanced portal tumor and lymph nodes simple, safe and effective method.