【摘要】 目的探讨超声造影引导¹²⁵I放射性粒子植入治疗肺外周部恶性肿瘤的临床应用价值。方法术前将CT等影像数据输入粒子治疗计划系统设定¹²⁵I放射性粒子布放计划,根据肺外周恶性肿瘤的超声造影结果调整粒子植入计划,于超声造影引导下将¹²⁵I放射性粒子植入肺外周部恶性肿瘤内,对采用该治疗的28例患者的临床随访资料进行回顾性分析。结果 28例患者均通过超声造影引导下肺穿刺活检获得确切的病理诊断,超声造影引导下¹²⁵I放射性粒子植入恶性肿瘤组织顺利,粒子分布满意,单个的瘤体内植入6～62粒¹²⁵I放射性粒子不等,术中、术后患者无明显出血等急性并发症。28例患者术后3例失访,其余25例随访时间0.8～43.9个月,中位随访时间8.23个月。术后总体有效率为88%（22/25）,其中16.0%（4/25）病灶完全缓解（CR）、8.0%（2/25）病灶部分缓解（PR）、64.0%（16/25）病灶控制（SD）、12.0%（3/25）肿瘤进展（PD）;治疗前后患者肺部肿瘤大小差异具有统计学意义（Z=62.50,P=0.007）。结论超声造影引导可精准地将¹²⁵I放射性粒子植入肺外周恶性肿瘤,操作安全可靠,粒子分布均匀,对控制肺外周恶性肿瘤局部进展疗效确切,无急性出血等并发症及放射性损伤发生,是晚期周围性肺癌较为理想治疗手段。更多还原

【Abstract】 Objective To explore the clinical application value of the implantation of ¹²⁵I guided by contrast-enhanced ultrasonography for the peripheral pulmonary malignant tumors.Methods The CT image data of pulmonary tumors were input into the treatment planning system to make the plans of ¹²⁵I seeds implantation.Then the plans would be adjusted according to the results of contrast-enhanced ultrasonography.28 cases of advanced peripheral pulmonary carcinoma were implanted ¹²⁵I seeds guided by contrast-enhanced ultrasonography according to the preoperative plans.The change of length diameter of tumor was analyzed.The follow-up clinical data of the 28 patients were retrospectively analyzed.Results All the 28 cases obtained definite biopsy pathological diagnosis through the lung puncturing guided by contrast-enhanced ultrasound.The total 28 cases were performed successfully according to the preoperative plans within 6-62 grains of ¹²⁵I seeds were implanted into individual tumors.The distribution of ¹²⁵I seeds were satisfactory.There were not obvious acute intraoperative and postoperative complications,such as bleeding.Although the 3 cases were lost to follow-up,another 25 cases were followed up for 0.8-43.9 months and the median follow-up time of 8.23 months.The results showed that the overall response rate was 88%（22/25）,complete remission（CR）was achieved in 16%（4/25）,partial remission（PR）was 8%（2/25）,stable disease（SD）was 64% 16（/25）and the progressive disease（PD）was 12%（3/25）.There were significant statistical differences of the tumor sizes between postoperative and preoperative（Z=62.50,P=0.007）.Conclusions The implantation of ¹²⁵I seeds for the lung peripheral malignant tumors should be guided by contrast-enhanced ultrasound precisely.The operation is safe and reliable,the distribution of the seeds in the tumors were uniform.It is effective to inhibit local progress of peripheral pulmonary malignant tumor as well as there are not complications such as acute hemorrhage and radioactive damages occurs.It might be a kind of more ideal clinical treatment for the advanced peripheral pulmonary carcinoma.更多还原