CT引导下^(125)I粒子治疗腹膜后恶性肿瘤穿刺路径分析

CT-guided ^(125)I seed implantation for the treatment of retroperitoneal malignant tumors: analysis of puncturing approaches

目的分析CT引导下125I粒子治疗腹膜后恶性肿瘤不同穿刺路径的安全性及可行性。方法回顾性分析25例CT引导下经肝、经胃、经十二指肠、经肠系膜间、经胸腰髂肋肌行125I粒子植入治疗的腹膜后肿瘤患者,其中腹膜后淋巴结转移癌21例、胰腺癌4例。患者术前均行充分的肠道准备,应用近距离治疗计划系统(TPS)制定术前计划;CT引导下,根据病灶位置不同选择相应的穿刺路径,采用1~3支植入针植入125I粒子;术后即刻扫描CT行验证计划。结果 25例均顺利完成手术,经肝路径21例,经胃路径9例,经十二指肠路径2例,经肠系膜路径2例,经胸腰髂肋肌路径5例。术后所有患者均未出现出血、腹膜炎、呕血、黑便等穿刺相关并发症。术前与术后粒子总活度、粒子数目及周边剂量(D90)差异无统计学意义。结论以上5种穿刺路径安全、可行;经空腔脏器植入时,需要有严格的外科围手术期管理措施。

Objective To investigate the safety and feasibility of different puncturing approaches in the performance of CT- guided 125I seed implantation for the treatment of retroperitoneal malignant tumors. Methods The clinical data of twenty-five patients with retroperitoneal malignant tumors, who had underwent CT-guided 125I seed implantation, were retrospectively analyzed. The puncturing approaches included trans- hepatic route, trans-gastric route, trans-duodenal route, and through mesentery and through thoracolumbar iliocostalis. The malignant tumors included retroperitoneal lymph node metastases （n=21） and pancreatic cancer （n=4）. Preoperative full bowel preparation was carried out in all patients, and treatment planning was formulated by using treatment planning system （TPS） before the procedure. Under CT guidance, proper puncturing approach was selected according to lesion＇s location. One to 3 needles were used to implant 125I seeds. Immediately after 125I seed implantation, CT scanning was performed to check the distribution of 125I seeds. Results CT-guided 125I seed implantation was successfully completed in all patients. The puncturing approaches used in this series included trans-hepatic route （n=21）, trans-gastric route （n=9）, trans-duodenal route （n=2）, through mesentery （n=2） and through thoracolumbar iliocostalis （n=5）. After the operation, no procedure-related complications such as bleeding, peritonitis, hematemesis or melena occurred in all patients. The postoperative 125I particle number, total activity and peripheral dose （D50） were not significantly different from the preoperative data. Conclusion The use of the five puncturing approaches mentioned above is clinically safe and feasible. Strict perioperative management measures should be carefully executed when through cavity organ implantation is employed.