经皮骨成形术联合^(125)I粒子植入治疗骨转移瘤临床应用

Clinical Application of Percutaneous Vertebroplasty Combined with ^(125)I Seeds Implantation in Treating Bone Metastases

目的探讨DSA引导下经皮骨成形术联合125I粒子植入术治疗骨转移瘤的临床应用价值。方法 30例(60个病灶)骨转移癌患者,年龄21~73岁,平均(56±5)岁。40个病灶同时行经皮椎体成形术及125I粒子植入术,20个病灶先行经皮椎体成形术,然后复查MRI后再行125I粒子植入术。采用视觉模拟评分(VAS)、肿瘤大小变化及行动功能改变评价疗效。结果所有患者至少随访6个月,手术均在DSA引导下成功完成,平均VAS评分由术前7.63±1.19降至:术后1天5.53±1.11,术后1个月3.97±1.40,术后3个月3.27±1.80,术后6个月2.27±2.03,术后12个月2.01±1.35。术后10例患者疼痛完全缓解(33.3%),18例患者部分缓解(60%),2例患者无效(6.7%)。术后1个月肿瘤局部有效率达到50%,术后3个月为70%,术后6个月为73.3%,术后12个月75%。术前20例行走困难者,术后有15例可独立行走,3例无改善,2例截瘫,行动能力改善率达到75%(15/20);10例术中发生骨水泥渗漏,均无临床症状。结论经皮骨成形术联合125I粒子植入术治疗骨转移瘤是一种安全、可行的有效方法。

Objective To discuss the clinical application of DSA-guided pereutaneous vertebroplasty （PVP） combined with 12sI seeds implantation in the treatment of bone metastases. Methods During the period from June 2012 to June 2013, a total of 30 patients with bone metastases （60 lesions in total） were admitted to authors＇ Department. The patients＇ mean age was （56 ±5 ） years old （21 -73 years）. PVP and ^125I seeds implantation were simultaneously carried out for 40 lesions ; while for other 20 lesions PVP was performed first, which was followed by reexamination of MRI with subsequent ^125I seeds implantation. The clinical efficacy was evaluated by visual analogue scale （VAS）, tumor size and improvement of clinical activity function. Results All patients were followed up for at least 6 months ; the operation were successfully accomplished under DSA guidance. The mean VAS score dropped from preoperative 7.63 ±1.19 to postoperative 5.53 ±1.11 （ one day after the procedure） , to 3.97 ±1.40 （ one month after the procedure） , to 3.27 ±1.80 （3 months after the procedure）, to 2.27 ±2.03 （6 months after the procedure）, and to 2. 01 ±1.35 （ 12 months after the procedure）. After the treatment, the pain was completely relieved in 10 patients （33.3%） and partially relieved in 18 patients （60%） ; the pain was not improved in 2 patients （6.7%）. The local effective rates at one, 3, 6 and 12 months after the treatment were 50% , 70% , 73.3% and 75% respectively. Before the treatment 20 patients had difficulty in walking. After the treatment, 15 patients could walk independently, 3 patients showed no improvement, and 2 patients developed paraplegia; the improvement rate of activity function was up to 75% （15/20）. Bone cement leakage occurred in 10 patients with no clinical symptoms. Conclusion For the bone metastases, percutaneous vertebroplasty combined with ^125I seeds implantation is a safe, feasible and effective treatment.