内镜下碘-125粒子置入腔内照射治疗胆管癌的临床研究

Clinical evaluation of Iodine-125 brachytherapy for cholangiocarcinoma

目的探讨经内镜碘-125（^125I）粒子置入腔内近距离照射治疗胆管癌的有效性和安全性。方法对65例胆管癌患者采用经内镜逆行胰胆管造影诊疗技术，自制^125I粒子施源器，应用各种方式将^125I粒子置入胆管腔内照射治疗胆管癌，并用不同更换粒子方法以提高局部照射剂量，术后定期复查胃镜及超声，评价操作可行性、临床有效性、并发症发生率。结果65例胆管癌患者顺利完成金属支架、单根及双根塑料支架置入，首次^125I粒子施源器置入单排59例、双排6例，初次照射平均活度5．775mCi；3个月后更换^125I粒子4例，6个月后更换41例，1年后更换5例，总照射剂量最高达14mCi。65例患者随访6～35个月，存活时间最长2例为35个月，共更换粒子3次，无严重并发症发生。结论内镜下^125粒子置入腔内持续照射治疗胆管癌明显延长患者生存期，胆道支架及”’I粒子施源器可分别随时更换，操作简便、创伤小。

Objective To evaluate efficacy and safety of Iodine-125 seeds used in brachytherapy for cholangiocarcinoma. Methods A total of 65 cases of cholangiocarcinoma patients were diagnosed and treated with ERCP. The Iodine-125 seeds were implanted into bile duct cavity by self-made carrier （ appli- cator） in various ways, and Iodine-125 seeds were replaced to improve the local irradiation dose. Follow- up was regularly made through endoscopy and ultrasonography to evaluate feasibility, efficacy and compli- cations. Results Self-expanding metal stents, single or double plastic stents were successfully placed in 65 patients. At first , single row of Iodine-125 seeds were inserted to 59 patients, double row Iodine-125 were inserted to 6 patients , and the average activity of the first irradiation was 5. 775 mCi. Iodine-125 were replaced in 4 patients after three months, in 41 patients after six months, in 5 patients after one year. The total dose was up to 14 mCi. In the follow-up of 6-35 months, the longest survival time was 35 months in two patients, where the Iodine-125 seeds were replaced 3 times as a whole and there was no serious complications. Conclusion Iodine-125 brachytherapy on cholangiocarcinoma by ERCP, where biliary stents and Iodine-125 seeds can be replaced at any time , is convenient, less invasive and can obviously prolong survival time.