术中^(125)I植入加5-氟尿嘧啶缓释剂瘤内注射治疗中晚期胰腺癌的临床观察

Clinical Study on Radioactive seed-^(125)I Implantation with Intratumor Injection of Slow-Release 5-Fu in Treatment of Advanced Pancreatic Carcinoma

目的:探讨125I植入+5-氟尿嘧啶缓释剂瘤内注射对中晚期胰腺癌患者的临床疗效。方法:2001年7月至2004年12月经手术探查不能切除胰腺癌患者23例,于术中在胰腺肿瘤实体内植入125I+5-氟尿嘧啶缓释剂200mg。术后随访治疗后的止痛效果与生存期。结果:①术后中位生存期为287d。其中,有9例术后经CT及MR I随诊,肿瘤较术前有不同程度缩小,占39.1%。有11例生存期超过1年,占47.8%。②术后止痛疗效:18例伴有上腹部及腰背部疼痛患者,术后有13例疼痛明显缓解(疼痛0级~1级),3例部分缓解(疼痛2级),2例无明显缓解(疼痛3级),有效率88.9%,显效时间3~5d。③2例经125I粒子治疗2个月后成功行胰十二指肠切除术。术后黄疸及十二指肠梗阻均减轻。④术后未出现胰瘘、淋巴瘘、放射性肠炎及腹腔内出血。术后复查,2例3个月后发现粒子迁移至肝脏。结论:术中探讨125I植入+5-氟尿嘧啶缓释剂瘤内注射能明显提高晚期胰腺癌患者的生存时间,而且明显减轻患者的疼痛症状。是一种用于治疗不能切除胰腺癌的较好方法。

Objective： To evaluate the therapeutic effect of intra - tumor implanted of Iodine - ^125 seeds with intra - tumor injection of slow - release 5 - Fluorouraeil （ 5 - Fu ） on advanced pancreatic carcinoma. Method： Twenty three cases of unreseetable and advanced pancreatic carcinomas were treated by Iodine - ^125 seeds implantation with intratumor injection slow - Release s - flworouracil （ 5 - Fu ）. The survival rate and efficiency of patients after treatment were statisical comparison. Results： （1）The median survival period attained 287d. Among them, 9 cases after treatment examinations by CT or MR/showed more or less the reduction of tumors at a certain degree, the rate is 39.1%. 11 cases , the life spans exceed 1 year , the rate is 47. 8%. （2）Pain was completely relieved in 13 cases, partially relieved in 3 eases, and no response was noted in 2 cases , So the effective rate of pain relieving was 88.9%, the median time was 3 - 5d. （3） 2 patients underwent panereaticoduodenectomy two month after implantation of ^125I. The jaundice and duodenai obstruction alleviated completely. （4）No complications occurred. The seed immigrated to liver in 3 eases . Conclusion： Intra - tumor implanted of Iodine - ^125 seeds with intra - tumor injection of slow - Release 5 - Fluorouraeil （ 5 - Fu ） on advanced pancreatic carcinoma in human could effectively prolong the survival time and relieve the pain, so it is an useful method for treating patients with unreseetable pancreatic carcinoma.