【作者】 刘瑞宝； 崔亚利； 潘雪玲； 岳同云； 殷淑莲； 隋林； 张星晔；

【Author】 Liu Rui-Bao Cui Ya-Li Pan Xue-Ling Yue Tong-Yun Yin Shu-Lian Cui Lin Zhang xingye The tumor hospital of Harbin medical university, Harbin, 150081

【机构】 哈尔滨医科大学附属肿瘤医院介入科；

【摘要】 目的:探讨CT引导下125Ⅰ粒子植入配合TACE对晚期肝癌的治疗方法及其价值。方法:20例经TACE治疗后的晚期肝癌患者,男16例,女4例。5例肺内转移,4例肾上腺转移,1例同时出现右肺内及右肾上腺转移,2例腰大肌转移,8例肿瘤突出于肝脏边缘DSA造影未见明确肿瘤供血血管,TACE治疗疗效欠佳。应用TPS系统确定粒子分布的剂量。应用GE16层螺旋CT,依据病变的部位分别采用仰卧、俯卧或侧位等不同体位行CT扫描,确定穿刺入路。CT引导下穿刺。肿瘤组织内分别植入活度为0．5—0．7的125I粒子(125Ⅰ 粒子由宁波君安药业公司提供),使125Ⅰ粒子在肿瘤内均匀分布。肺内肿瘤穿刺过程中出现气胸气体较多者于治疗后抽出胸腔内的气体。肝脏及肾上腺肿瘤穿刺前静脉内注入1Ku立止血,穿刺过程中出血较多时于术中经穿刺针肿瘤组织内注入止血药物。病灶较大者可分两次完成治疗。结果:20例患者全部按TPS系统制定的计划完成治疗,共植入125Ⅰ粒子623 粒。其中,肺内植入86粒,平均14．3粒／例,肾上腺176粒, 平均35粒／例,腰大肌旁转移瘤植74入粒,平均37粒／例, 肝癌内植入287粒,平均35．8粒／例。治疗过程中除1例肝癌患者粒子进入门静脉发生粒子移位外,无其它严重并发症发生。粒子植入一月复查,全部病人的临床症状均有改善, AFP明显降低(p<0．05)。CT复查显示所有病灶均缩小。结论:CT引导下125Ⅰ粒子植入配合TACE是治疗晚期肝癌的有效方法,特别适合于出现其他脏器转移或肿瘤位于肝脏边缘,血供不丰富,微波、射频,氩氦刀等治疗易发生肿瘤残留的患者。操作安全,疗效显著。更多还原

【Abstract】 Objective: To investigate the value of CT guiding 125Ⅰ seed implantation combined with TACE in patient with advanced liver cancer. Methods: 20 patients with advanced liver experienced TACE before CT guiding 125Ⅰseed implantation. 16 male and 4 female.5 of them have metastatic node in their lungs, new node was founded in adrenal in 4 of these patients, Metastatic node was found in right lung and adrenal at the same time in one patient Metastases. take placed muscle in two cases, no evidence supplying vascular were found in 8 cases, which tumor exist in the edge of the liver, and no satisfied result was found in these 8 patient The doses were decided according to TPS. CT guiding puncture was performed under 16 Light speed spiral CT in different position according to the site of the tumor.125I seeds were implant evenly in tumor according to TPS. Complication such as pneumothorax or blooding was treated during the operation. Results: 623 125Ⅰ seed was implanted in 20 patients success according to TPS. 86 seed in lung, 176 seed in adrenal, and 74 seed in muscle and 287seed in liver. One seed was found immigrate in portal venous during the operation. No other complication occurred. General condition was improved in all the 20 patients a month after the operation. Serum AFP descent (P < 0.05 ) Follow up CT show that all the tumor treated are small than before. Conclusion: CT guiding 125Ⅰ seed implantation combined with TACE is a safe less invasive and practical method especially in patient with advanced liver cancer更多还原