^(125)I粒子组织植入治疗难治性海绵血管瘤的临床应用

^(125)I seed implantation therapy for refractory hemangiomas

目的:探讨125I粒子组织植入在难治性海绵血管瘤治疗中的可行性。方法:选择2005-01/2006-03长海医院整形外科收治的海绵血管瘤患者4例,经患者知情同意后行I粒子组织植入治疗,且得到医院伦理道德委员会批准。术前行CT/MRI或/和B型超声波检查,详细计算瘤体体积和所需处方剂量。植入粒子时应该避开神经,距离应大于17mm为宜。放射性粒子采用中国原子能科学院生产的外形为圆柱状钛合金封体的125I放射粒子源(批号:国药准字H20045969),长4.5mm,直径0.8mm,平均能量27～35keV,半衰期60.1d,半价层0.025mmPb,组织穿能力为1.7cm。术中经皮组织间永久植入125I粒子,粒子以1.5～2.0cm的间距均匀排布于血管瘤组织中。术后应用CT/MRI检查血管瘤的体积变化,应用X射线检查有无粒子丢失或游走。结果:4例患者全部进入结果分析,无脱落。①全部病例共植入125I粒子97粒,平均24.25粒,其中最少20粒,最多30粒。粒子平均活度1.85×107Bq,共1.79×109Bq。②术中患者未见不良反应,术后血液学检查正常。③所有病例均获得随访,随访时间分别为10,12,14,24个月。随访期内CT/MRI检查可见肿瘤体积均有不同程度的缩小;肿瘤无复发,无明显放疗反应;X射线监测无粒子丢失或游走。结论:应用I粒子植入治疗血管瘤,具有操作简单、患者痛苦小、见效快等优点,初步结果满意,有望成为治疗血管瘤的新方法。

AIM： To investigate the feasibility to cure refractory hemangiomas by^125 radioactive seeds implantation. METHODS： Four patients with refractory hemangiomas who were hospitalized at Department of Plastic Surgery of Changhai Hospital were selected between January 2005 and March 2006. After obtaining the informed consent and approval from the Ethics Research Committee, all cases were treated by^125 seeds implantation. CT/MRI-scan and/or B-type ultrasonic inspection was performed before operation, and the volume of hemangioma and the required prescription dose were calculated carefully. During treatment, the nerve should be avoided, with a suitable distance of more than 17 mm. Radioactive seed source of^125 seeds was produced by China Institute of Atomic Energy （No. H20045969）, it was cylinder and made of titanium alloy, 4.5 mm in length, 0.8 mm in diameter, average energy of 27- 35 keV, half life period of 60.1 days, half value thickness of 0.025 mm Pb, and tissue penetration of 1.7 cm. Intraoperative interstitial implantation of^125 seed was carded out evenly over the whole hemangiomatous tissue, and seeds were arranged with 1.5-2.0 cm interval. Postoperative CT or MRI was performed to examine the hemangiomatous changes in size, and X-ray to check if there was seed loss or migration. RESULTS： All four cases were involved in the result analysis with no loss. ①Ninety seeds were implanted, with an average of 24.25 and at least 20 tablets. The average activity of seeds was 1.85x10^7 Bq, a total of 1.79x10^8 Bq. ②No adverse reaction was found during operation, and hematology test was normal after operation. ③AII patients were followed up for 10, 12, 14, and 24 months, during which the hemangiomatous volumes were narrowed in various degrees. No local regional recurrence was observed, nor was any complication related to the treatment. X-ray monitoring found no seed loss or migration. CONCLUSION： ^125 seed implantation shows many advantages like simple, utility and less pain for patients; moreover, its primary result is satisfactory. Therefore, it is expected to become a new treatment for hemangioma.