超声引导下~125I放射性粒子植入治疗原发性肝癌的临床观察

Values of ultrasonography guidance in percutaneous ^(125)I seed implantation for advanced liver cancer

目的:探讨超声引导下经皮穿刺植入125I放射性粒子治疗原发性肝癌的应用价值。方法:采用三维治疗计划系统(3D-TPS)计算48例肝癌患者51个病灶125I植入剂量,在超声显示肝脏病灶后,将125I粒子按外周密植、中间疏植的原则经皮穿刺植入肿瘤内。术后2周行超声检查,观察有无腹腔出血等并发症,术后2个月行AFP检测、彩超、CT或MR检查评价治疗效果。结果:125I放射性粒子治疗48例原发性肝癌后,12周内31例患者AFP降至正常,12例患者较术前下降一半,5例无变化,有效率为89.58%;51个病灶完全缓解23个,部分缓解21个,无变化6个,进展1个,总有效率为86.27%,无严重并发症。结论:超声引导下经皮穿刺植入125I放射性粒子治疗肝癌创伤小,布源合理,疗效肯定,并发症少,操作简单,实用性强。

OBJECTIVE： To investigate the clinical application values of ultrasonography guidance in percutaneous 125I seed implantation for primary liver cancer. METHODS： Preoperatively, the treatment planning system （TPS） was used to reconstruct three dimensional images of the tumor and to calculate the estimated seed, radiation dose, of which 51 lesions of 48 patients with liver cancer. After the ultrasonography showed the liver lesions,the 12s I seed was percutaneous implanted high density at periphery of the liver lesions and sparse in the middle. Two weeks later,check the symptom of with or without abdominal bleeding or other complications by the ultrasonography. After 12 weeks of the postoperative,e- valuate the therapeutic effect by detect alpha-fetoprotein （AFP） level, color Doppler ultrasound, CT or MR examination. RESULTS：After 12 weeeks,with 31 cases of 48 primary liver cancer patients that serum AFP level decreasing to normal range. Twelve patients showed more than a 50% decrease in their serum AFP levels from preoperative,indicating the o- verall response rate equal to 89.58%,whereas 5 patients had no significant trend of decreasing. Of All the 51 lesions, 23 lesions achieved complete remission （CR）,21 lesions were seen partial remission （PR）, 6 lesions was stable and one was progression,suggesting the overall response （CR＋ PR） rate was 86. 27%. No severe adverse events were observed. CONCLUSION： Ultrasonography guidance percutaneous implantation of 125I Seed treatment of liver trauma, which fabric source is reasonable, effective and with few complications, the operation is simple and practical.