CT导引经皮穿刺注射无水乙醇治疗溶骨性骨转移瘤

CT guided Percutaneous Ethanol injection to treat osteolytic metastases

目的探讨CT导引下经皮穿刺注射无水乙醇（CT～PEI）治疗溶骨性骨转移瘤的价值及安全性。方法对17例骨转移瘤患者（25个病灶）采用CT—PEI治疗，使用无水乙醇和超化碘油10：1的混合剂，用CT精确定位、准确穿刺瘤灶并密切监控无水乙醇弥散情况及用量，以减少并发症。对接近椎管及椎间孔的病灶，采用利多卡因实验性治疗以避免严重并发症。术前及术后定期CT检查，3例病人行同位素骨扫描检查，与治疗前检查进行对照研究。对患者随访3～30个月观察其临床疗效。结果所有患者经1次CT—PEI治疗后，疼痛即明显减轻，经2～3次CT-PEI治疗后疼痛完全缓解（CR）16例（24处病灶），疼痛部分缓解（PR）1例。术后随访3个月时，23处病灶内肿瘤组织均发生坏死，被高密度碘油混合液均匀浸润。其中，9处病灶体积缩小。随访3～30个月，除1例因周边出现新的肿瘤浸润灶而再次出现疼痛，其余病例转移瘤处止痛效果无反复。所有病例无严重并发症。结论CT—PEI是一种治疗骨转移瘤有效、微创、安全、简便的方法，使骨转移瘤内肿瘤组织坏死，最大限度的杀灭肿瘤细胞，从而达到满意的止痛效果，明显改善恶性肿瘤溶骨性转移病人的生活质量。

Objective To assess the safety and efficacy of the CT guided percutaneous ethanol injection.（CT-PEI） in terminally ill cancer patients with painful osteolytic bone metastases. Methods Seventeen patients with 25 bone metastases in various locations underwent percutaneous injection of a 10 ： 1 mixture of absolute ethanol-iodized oil （lipioclol ultra-fluid ） under CT guidance, which allowed precise needle positioning and control of the diffusion ancl quantity of alcohol thus minimizing the complications, when osteolysis involves the vertebral foramen ancl the intervertebral foramen, lidocaine （2%） must be injected first as a test injection to avoid the serious complications. Follow-up contrast material-enhanced computed tomography and three cases with nuclidic scan of bone were performed regularly after the procedures. Compare the images with those before the treatment. The follow-up time was from 3 to 30 months. Results After 1 CT-PEI procedure, all cases experienced a marked pain relief and reduction of analgesic needs. The rate of completed pain relief （CR） was demonstrated in 96% after 2 to 3 procedures. 23 lesions ethanol filling was obtained in 100%, which present with extensive areas of necrobiosis at 3 months after the treatment. In the follow-up time, the sizes of 9 tumors gradually decreased and only one ease experienced a recurrent pain. No serious complications were observed. Conclusion Percutaneous ethanol injection under CT guidance is an useful, less invasive, safe and easy manipulated procedure, which kill the tumor cells at the greatest possible quantity to reduce the pain and improving the quality of life of patients with osteolytie metastases.