CT导向下组织间植入^(125)I粒子在脊柱转移瘤中的应用

Application of CT-guided interstitial ^(125)I seeds implanted in spinal tumour metastases

目的:介绍CT导向下组织间植入125I粒子治疗脊柱肿瘤的技术方法并评价其临床价值。方法:10例脊柱转移瘤病人,均在CT引导下进行肿瘤内125I粒子植入术。使用的设备为Phlips公司生产的多排螺旋CT(MX8000),并配有Pin-point光学引导系统,采用珠海和佳公司产的TIPS计划系统及穿刺针,中科院生产的125I粒子。首先根据肿瘤的大小利用放射性粒子治疗计划系统计算出治疗肿瘤所需要125I粒子的最佳数量,然后经CT导向下经皮穿刺将125I粒子均匀植入到肿瘤内进行组织间放疗,所有病人术后1月、2月、3月内分别进行CT检查随访,根据肿瘤大小变化将疗效分4级:Ⅰ级:明显缓解(肿瘤缩小50%以上)Ⅱ级:缓解(肿瘤,软组织肿块缩小25%~50%)Ⅲ级:轻度缓解或肿瘤虽然大小无明显变化,但临床症状明显缓解。(肿瘤,软组织肿块缩小1%~25%)Ⅳ级:无效(肿瘤,软组织肿块无变化或增大,临床症状亦无缓解)。结果:1月:Ⅰ级1例,Ⅱ级1例,Ⅲ级5例,Ⅳ级3例;2月:Ⅰ级4例,Ⅱ级3例,Ⅲ级2例,Ⅳ级1例;3月:Ⅰ级5例,Ⅱ级3例,Ⅲ级1例,Ⅳ级1例。结论:CT导向下组织间植入125I粒子是一种治疗脊柱肿瘤安全、可靠、疗效显著的治疗方法。

Objective： To introduce the procedures and evalaate the clinic value of CT-guided interstitial ^125I seeds implanted in curing spinal turnout. Methods：36 cases patients with lung cancer underwent CT-guided interstitial ^125I seeds implanted. All patients were performed under mulfi-spiral CT （Philips, Mx8000） with optical navigating system （Pinpoint）, used TPS, needle and ^125I seeds （Chinese academy of science）. First of all, according to size of tumor, TPS calculated the optimal quantity of seeds; then, under guidance of CT, ^125I seeds werepercutaneous implanted into tumor for interstitial radiotherapy. CT examination were performed 1, 2, 3 months after therapy respectivdy, and according to the size of tumor, curative effect were graded 4 grades： Ⅰ grade, obvious relief （the size of tumor reduced up to 50% ）; Ⅱ grade： relief （the size of tumor reduced by 25% ～ 50% ）; Ⅲ grade： slight relief （the size of tumor reduced by 1% ～ 25% ）; Ⅳ grade： no effect （the size of tumor did not reduced or increased, and clinic symptoms were not relief）. Results： 1 month：1 cased Ⅰ grade, 1 cased Ⅱ grade, 15 casesof Ⅲ grade, 3 cases of Ⅳ grade; 2 months：4 cases of Ⅰ grade, 3 cases of Ⅱ grade, 2 cases of Ⅲ grade, 1 case of Ⅳ grade; 3 months： 5 cases of Ⅰ grade, 3 cases of Ⅱ grade, 1 case of Ⅲ grade, 1 case of Ⅳ grade. Conclusion： CT-guided interstitial ^125I seeds implanted was a safe, reliable and effective curative method of spinal turnout.