术中超声引导下^(125)I粒子植入放射治疗胰腺癌17例临床观察

Ultrasound-guided intraoperative ^(125)I seed implantation for pancreatic carcinoma: A clinical observation of 17 cases

目的探讨超声引导125I放射性粒子植入治疗晚期胰腺癌的可行性和效果。方法术前根据肿块大小计算放射总剂量、粒子数量及间距。全麻后术中超声实时监视,均匀布针并植入粒子。术后超声及/或X线片确认植入部位及有无漏植。结果17例手术均获成功。术中超声清晰显示肿块,准确引导植入针的插入,成功监视粒子的植入,术后证实植入部位准确。术后1个月5例肿块消失,肿瘤缩小>50%7例,<50%5例。腹痛7例,3天后疼痛均消失。4例术后发热,2例腹水,2例各有1颗粒子迁徙到肝脏。所有患者术后1周左右均出现了胃肠道症状。除3例因多脏器功能衰竭死亡外,其余14例至2004年8月已存活2~26个月(平均10个月)。结论该项技术可行,具有明显姑息治疗作用。

Objective To investigate the feasibility and effect of ultrasound-guided intraoperative 125 I seed permanent brachytherapy for terminal pancreatic carcinoma. Methods We determined the total radiation dose and the number and spacing of radioactive seeds before operation according to the size of tumors. The operation was performed under general anesthesia. Under the guidance of real-time ultrasonography, the needles were inserted evenly into the lesions and radioactive seeds were implanted through the needles. At the end of operation, we applied ultrasonography and/or abdominal radiography to examine the distribution of seeds and to avoid missed implantation. Results All the 17 patients were operated on successfully. In operation the lesions were displayed clearly with ultrasonography. With the assistance of ultrasonography, we inserted needles exactly into the tumors and successfully monitored the whole process of the seed implantation. The positions of seeds were proved correct by ultrasonography or abdominal radiography after operation. At the first postoperative month, the mass disappeared in 5 patients, and decreased in size >50% in 7 patients and <50% in 5 patients. Abdominal pain occurred in 7 patients postoperatively and subsided 3 days after operation. Postoperative pyrexia happened in 4 patients, and posttreatment ascites, 2 patients. In 2 patients, one seed was found having migrated to the liver. Symptoms of the digestive tract were observed in all patients about 1 week after operation. With the exclusion of 3 patients who died of multiple organ failure,the remaining 14 patients have survived for 2~26 months (mean, 10 months) up to August 2004. Conclusions Ultrasound-guided intraoperative 125 I seed implantation is a feasible palliative treatment for pancreatic carcinoma.