赝复体联合放射性粒子植入治疗腭部恶性肿瘤

^(125)I Brachytherapy of Postoperative Palatal Gland Malignancies

目的:探讨赝复体联合125I放射性粒子植入术在口腔颌面部腺源性恶性肿瘤靶向放疗中的初步应用并评价其疗效。方法:从2009年起在就诊于我科的颌面部腺源性恶性肿瘤患者中,选择腭腺肿瘤患者5例。5例患者在术前经CT检查,设计粒子植入靶区方案。在全麻下先手术切除肿瘤组织,2周后按照术前设计方案,分层立体式植入125I放射性粒子。同期行上颌腭部缺损取模,设计并制作赝复体义齿,在近瘤腔的赝复体基托组织面呈球形埋入数枚放射性粒子。术后随访观察患者的治疗效果及副反应。结果:术后随访2～15个月,所有患者均未发现靶区所覆盖范围肿瘤复发或转移。所有5例患者戴用赝复体均感语音、咀嚼、面容明显改善,除2例患者有舌体轻度烧灼感外,无任何不适主诉。结论:对腭部腺源性恶性肿瘤患者,手术切除后采用赝复体放射性粒子埋入联合组织间放射性粒子植入的方法,对靶区行立体式、全方位的放射治疗,在增强放疗效果、防治肿瘤的复发和转移、提高患者的生活质量等方面近期效果较好,不良反应小。

Objective： To evaluate the clinical effects of brachytherapy of 125I radioactive seed implantation combined with prosthetic denture in the postoperative treatment of palatal salivary gland malignancies.Methods： Five patients were retrospectively reviewed.Two weeks after surgical dissection of the tumor,the 125I radioactive seeds were implanted into the palatine tissue.Meanwhile,radioactive seeds were embedded in the tissue surface of the protheses and applied for the operative defect.24 to 36 seeds were used for each patient（average of 28 seeds）.All the patients were followed-up for 2 to 15 months.Results： No tumor recurrence or metastasis was found around the target area in all five patients.Significant improvement was demonstrated in the aspects of speech,mastication and facial appearance for all 5 patients.Conclusions： For patients with the glandulae palatine malignancy,tumor dissection and later radioactive seed implantation combined with prostheses denture may be effective for preventing recurrence and metastasis of malignancy and improving the quality of life,and a long term follow-up is necessary.