放射性粒子^(125)I植入治疗12例早期肾癌的临床观察

Clinical study of radioactive seed ^(125)I implantation in treatment of 12 cases of early stage renal cell carcinoma

目的:评价CT引导下瘤体内125I粒子植入治疗早期肾癌的可行性、安全性及其疗效。方法:对12例肾癌患者的15个病灶在CT引导下行瘤体内125I粒子植入治疗,植入术后立即CT扫描观察粒子在瘤体内的分布,术后随访观察有无并发症发生。结果:12例患者均顺利完成手术,平均时间43(30～50)min。单个瘤体内植入125I粒子数为1～19粒(平均8粒)。术后6个月CT扫描显示粒子分布满意,15个病灶中4个消失,7个明显缩小,3个病灶稳定,1个进展。1例孤立肾患者术后3个月发现肉眼血尿,经保守治疗后消失。12例患者未见治疗相关的放射损伤。平均随访36(6～52)个月,1例术后13个月死于心肌梗死,2例术后18和22个月死于多发肺转移。余9例正常生存。结论:CT导引下125I粒子植入治疗对早期肾癌是一种可供选择的安全、有效治疗方法。

OBJECTIVE：To evaluate the feasibility,safety and efficacy of the CT-guided intratumoral 125I particle implantation for early stage renal cell carcinoma.METHODS：125I seeds were implantated in 15 intratumoral lesions of 12 patients with renal cell carcinoma with CT guided.The distribution of 125I seeds in vivo in the tumor was immediately observed after the implantation with CT scanning,and the complications and efficacy were followed up.RESULTS：Twelve patients were successfully operated,the average time of operation was 43 （range 30-50） min.One to 19 （average 8） 125I particles were implantated in single intratumoral lesion.Six months after the surgery,the particle distribution was satisfactory which was showed by CT scanning,4 lesions disappeared and 7 significantly reduced,and 3 lesions were of stability,and one was of progress in 15 intratumoral lesions.Three months after surgery hematuria was found in one solitary kidney patient and disappeared after conservative treatment.There was no radiation damage.With a mean follow up of 36（6-52） months,one patient died of myocardial infarction 13 months later,two patients died of multiple lung metastasis 18 and 22 months later,and nine patients were alive.CONCLUSION：125I seed implantation for renal cell carcinoma under the guidance of CT is a safe,minimal invasive,and high effective therapy,especially for patients who are reluctant or inoperable to surgery.