三维适形放疗结合高强度聚焦超声治疗腹膜后淋巴结转移癌的疗效观察

Observation of curative effect of three dimensional conformal radiation therapy combined with high intensity focused ultrasound for retroperitoneal lymph nodes metastatic carcinoma

目的观察三维适形放疗(3DCRT)联合高强度聚焦超声(HIFU)治疗消化道恶性肿瘤腹膜后淋巴结转移的近期疗效。方法选择住院治疗的腹膜后淋巴结转移癌患者102例,采用抽签法分为3DCRT组和联合组各51例,3DCRT组给予3DCRT,联合组在3DCRT基础上加HIFU治疗,两组疗程均为3个月,比较两组淋巴结大小改变情况,治疗前后的疼痛评分、吗啡用量变化情况,治疗后患者的梗阻缓解情况、不良反应发生情况。结果两组淋巴结大小改变情况比较差异有统计学意义(P<0.01),联合组淋巴结消退情况好于3DCRT组。两组治疗前的疼痛评分、吗啡用量比较差异无统计学意义(P>0.05),治疗后两组疼痛评分均显著下降(P<0.01),吗啡用量均显著减少(P<0.01);联合组的疼痛评分显著低于3DCRT组(P<0.05),吗啡用量显著少于3DCRT组(P<0.01)。两组患者的梗阻缓解情况、不良反应发生情况比较差异无统计意义(P>0.05)。结论对腹腔淋巴结转移癌,3DCRT、HIFU联合治疗的近期疗效明显优于单纯的3DCRT,且不良反应少,临床应用价值较高。

Objective To observe short-term curative effect of three dimensional conformal radiation therapy （3DCRT） combined with high intensity focused ultrasound （HIFU） in the treatment of retroperitoneal lymph node metastasis of malig- nant digestive tumor.Methods 102 patients with retroperitoneal lymph nodes metastatic carcinoma,who received hospitaliza- tion were collected, and they were randomly divided into 3DCRT group and combination group with 51 cases in each group. The 3DCRT group were given 3DCRT,while the combination group were added HIFU based on the 3DCRT.Both groups were treated for 3 months.Then, changes of lymph node sizes, pain scores before and after treatment, changes of morphine doses, ob- struction alleviation situation and occurrence of adverse reactions after treatment of the two groups were compared.Results Difference of comparison of changes of lymph node sizes was statistically significant between groups（P〈0.01 ）. Obstruction alleviation situation of the combination group was better than that of the 3DCRT group.No statistically significant difference was found in pain scores and morphine doses between groups before treatment（P〉O.05）.After treatment,pain scores of both groups significantly decreased （P〈0.O1）, and morphine doses obviously reduced （P〈0.01）, pain scores in the combination group was significantly lower（P〈0.05）, and morphine doses was less than that of the 3DCRT group （P〈0.01）. In addition, differences of obstruction alleviation situation and occurrence of adverse reactions were not statistically significant between groups（P〉0.05） .Conclusion Curative effect of HIFU combined with 3DCRT is obviously superior to that of single use of 3DCRT in the treatment of retroperitoneal lymph nodes metastatic carcinoma.It has fewer adverse reactions and higher value of clinical application.