CT导向下介入^125Ⅰ粒子置入联合化学消融治疗腹膜后恶性肿瘤

CT-guided ^125Ⅰ radioactive seeds implantation and chemical ablation for malignant retroperitoneal tumors

目的探讨CT导向下^125Ⅰ粒子置入和无水乙醇碘化油混合液介入治疗腹膜后恶性肿瘤的效果。方法回顾性分析19例复发或转移性腹膜后恶性肿瘤患者的介入治疗方案和临床资料。19例患者临床主要症状为腰、腹部疼痛，按主诉疼痛程度分级法（VRS法）分级，轻度疼痛8例、中度疼痛8例、重度疼痛3例，均拒绝再次手术治疗，并且病理证实为软组织来源的肿瘤，对化疗及外照射治疗欠敏感。因此，对患者采用CT导向下^125Ⅰ放射性粒子置入及无水乙醇碘化油混合液注射治疗。粒子置入之前采用放射性粒子治疗计划系统模拟布源或遵循Halarism的^125Ⅰ经验公式，求出术中所需^125Ⅰ粒子的总活度及算出治疗粒子的数量。在螺旋CT导向下将^125Ⅰ放射性粒子置入腹膜后肿瘤内。对于进针路径受限，粒子不能完全按计划分布的患者，采用无水乙醇碘化油混合液（比例为9：1）注射弥散的方法，覆盖病灶，确保最大范围杀灭肿瘤组织。首次治疗1个月后，按疼痛缓解4级法评价疼痛缓解情况；首次治疗后6个月以增强CT扫描结果作为评价依据，参考世界卫生组织实体肿瘤疗效评价标准进行影像评价。结果19例患者，首次治疗后1个月疼痛症状获得不同程度缓解，所有轻度疼痛患者完全缓解；中度疼痛患者6例完全缓解，2例部分缓解；重度疼痛患者完全缓解、部分缓解、轻度缓解各1例。首次治疗后6个月影像评价肿瘤治疗效果：完全缓解10例，部分缓解7例，稳定2例。19例目前全部存活，随访时间7．0～31．0个月，平均生存期13．5个月。结论CT导向下的粒子置入联合化学消融是治疗腹膜后恶性肿瘤的有效方法，

Objective To explore the clinical value of CT-guided ^125Ⅰ radioactive seeds implantation and chemical ablation for malignant retroperitoneal tumors. Methods Because of the rejection of the second surgery resection and insensitivity of chemotherapy and radiotherapy, nineteen patients with recurrent or metastasis malignant retroperitoneal tumors were treated by CT-guided ^125Ⅰ radioactive seeds implantation according to TPS or Halarism＇s experienced function, and percutaneous ethanol injection was performed if the way of punctuation was limited. The extent of pain relief was assessed one month later after therapy. All the patients received enhanced CT scan 6 months after the first treatment, and imaging evaluation was performed according to WHO criteria. Results For the 19 patients, pain relief was achieved more or less in all patients. Imaging evaluation revealed complete relief, partial relief, no change in 10, 7, 2 cases respectively. All patients are still alive now. The longest followed span is 31 months, and the shortest is 7 months, the average followed span is 13.5 months. Conclusion CT-guided ^125Ⅰ radioactive seeds implantation and chemical ablation are effective for malignant retroperitoneal tumors.