胰腺癌CT导引近距离放疗穿刺入路选择技术与策略

CT-guided Iodine-125 brachytherapy for pancreatic cancer:feasibility and utility of pretreatment gastrointestinal preparation combined multiaccess implantation

目的探讨胰腺癌125I永久性插植放疗前术前胃肠准备结合多入路穿刺技术进行粒子布源的可行性和应用价值。方法回顾分析136例(男91例,女45例)胰腺癌患者经CT导向下125I粒子插植放疗,患者平均年龄为61.6岁(48～82岁)。其中胰头癌53例,胰颈癌21例,胰体癌35例,胰尾癌13例,全胰腺癌24例。平均3.74cm(2.85cm～6.5cm);33例肝内单发转移,16例多发转移,67例腹腔干周围淋巴结肿大。所有患者均存在不同程度的持续性腰背部或腹部疼痛。所有患者均存在不同程度的持续性腰背部或腹部疼痛。125I植入前39例行胆肠吻合,17例行支架或引流减黄;25例行外放疗,33例行静脉或动脉化疗。61例治疗前、后肝转移行动脉化疗。所有患者均行术前胃肠道准备,并采用多入路结合125I粒子植入。患者术后1、2、3月行增强CT扫描,以后为每3个月一次,同时检查肿瘤标志物,术后随访9～43个月。结果本组136例病人手术均按计划顺利完成,术前胃肠道准备有效率为76.5%(91/103)。无一例术中及术后出现胰漏、胆漏、出血、脏器穿孔及感染等主要并发症。术后一年内疼痛缓解率87.5%(119/136),局部有效率83.75%(114/136),患者一年、二年和三年生存率分别为49.4%,23.6%和6.3%;中位生存期16.7月;平均无进展生存期为11.4月。结论术前进行严格的胃肠道准备结合多入路穿刺提高胰腺癌125I插植近距放疗的操作成功率,并可有效控制并发症发生率。

Objective to evaluate the feasibility and utility of pretreatment gastrointestinal preparation combined multi-access needle puncture for 125I implantation in pancreatic cancer treatment. Methods Retrospectively evaluate 136 patients （male, 91; female, 45） （mean age, 61.6; range, 48- 82） underwent CT-guided percutaneous 125I implantation or intraoperating implantation in pancreatic cancer treatment. There were 53 in head of pancreas, 21 in neck of pancreaa, 35 in body of pancreas, 13 in tail of pancreas and 24 in whole pancreas. The diameter of lesions ranged 2.85-6.5cm （mean, 3.74cm）. 33 patients were found with single metastases of liver, 16 with multi-metastases, 67 were found with enlargement of lymph nodes around the celiac trunk. 39 patients performed pretreatment of chol-intestinal anastomosis. 17 patients performed biliary tract drainage or stent implantation. 25 patients underwent external radiotherapy and 33 underwent chemotherapy by artery or vein. 61 patients with liver metastases underwent chemotherapy by artery. 32 patients underwent intraoperating implantation and 136 underwent CT-guided implantation. All patients underwent pretreatment gastrointestinal preparation; multi-access !mplantation was performed according to the treatment plan. Enhancement CT scan was performed 1, 2, 3, months after 1251 implantation, and every 3 months after. Tumor markers were also tested simultaneouly. Follow up the patients for 9-43 months. Results： a total of 136 patients underwent ~25I implantation successfully, no major complications occurred. The efficacy of gastrointestinal preparation was 76.5%（91/103）. Easement of pain acquires in 119（87.5%） of 136 patients. Local effective rate was 83.75% （114 of 136）. One-year, 2-year and 3-year survival rate reached 49.4%, 23.6% and 6.3%, respectively. Mesa-life span was 16.7 months, mean progression free survivalwas ll.4months. Conclusion：CT-guided 125I seed implantation after pretreatment gastrointestinal preparation combined multi-access needle puncture provides a safe and effective alternative in pancreatic cancer.