^(125)Ⅰ放射性粒子术中植入联合动脉置管区域性灌注化疗治疗晚期胰腺癌

Treatment of late-staged pancreatic carcinoma with implantation of ^(125)I seeds in combination with regional arterial infusion chemotherapy

目的探讨^(125)Ⅰ粒子术中植入联合动脉灌注区域性化疗对晚期胰腺癌的治疗价值。方法对晚期胰腺癌患者行术中穿刺或切取活检明确病理诊断。^(125)Ⅰ粒子平铺于瘤床或瘤体内插植,动脉化疗泵经胃左动脉或胃网膜右动脉植入,远端置于肝总动脉或腹腔动脉干,必要时行胆肠和(或)胃肠吻合术。术后化疗方案为吉西他滨(1000 mg/m^2)联合氟尿嘧啶(5-Fu)(500 mg/m^2),每周1次,连续7周。结果所有7例患者平均植入放射性粒子42粒,平均剂量29.4 mCi。平均随访245d[(123～332)d],疼痛缓解率100%,肿瘤缩小4例,转移灶缩小、减少2例。糖链抗原19-9(CA19-9)水平全部降至正常。1例术后发生胰漏,行保守治疗而愈。结论 ^(125)Ⅰ放射性粒子术中植入联合动脉置管区域性灌注化疗适用于有手术指征的晚期胰腺癌,可有效缓解临床症状,改善患者生活质量。

Objective To evaluate the effect of combined use of implantation of ^125I seeds with regional arterial infusion chemotherapy on late-staged pancreatic carcinoma.Methods During operation, ^125I seeds were implanted into tumor parenchyma or operative beds for 7 patients with pathological diagnosis of late-staged pancreatic carcinoma, then chemotherapy pump was implanted into common hepatic artery or celiac artery through left gastric artery or right epigastric artery. Gemcitabine（ 1000 mg/m^2 ） plus fluorouracil （500 mg/m^2） was used for postoperative adjuvant chemotherapy once a week for 7 consecutive weeks. Results The mean numher of implanted ^125I seeds was 42 and the mean dose was 29. 4 mCi. The mean follow-up time was 245 days. Bate of pain rehef was 100%, metastasis foci was reduced in 2 cases. CA19-9 level decreased to normal in all patients. Pancreatic fistula occurred in one case and was cured with conservative therapy. Conclusious The combination therapy is effective for late-staged pancreatic carcinoma, it brings symptom rehef and improvement in quality ,of life.