CT引导下^(125)I粒子植入治疗纵隔淋巴结转移的应用价值

The Application Value of CT-guided ^(125)I Radioactive Particles Implantation in Treating Metastatic Tumor of Mediastinal Lymph Nodes

目的:观察CT引导下^(125)I粒子植入治疗纵隔淋巴结转移的疗效。方法:采用CT引导下^(125)I粒子植入治疗纵隔淋巴结转移患者32例,术后随访,观察患者术中、术后并发症情况以及治疗后2个月、4个月、6个月复查CT,了解局部肿瘤病灶控制情况,判定近期疗效,检测、统计患者术前、术后T细胞亚群及自然杀伤细胞(NK细胞)活性,观察患者免疫功能变化情况;结果:32例纵隔淋巴结转移瘤患者均顺利完成^(125)I放射性粒子植入术,术中、术后局部少量出血、气胸、咯血和低热等并发症发生率分别为21.9%、12.5%、18.8%、25%;术后2个月、4个月和6个月,患者^(125)I粒子植入治疗的总有效率分别为81.2%、90.6%和84.4%;术后14d、21d、28d患者体内CD4^+、CD4^+/CD8^+及NK细胞水平较术前明显升高,差异有统计学意义(P<0.05),^(125)I粒子植入治疗肿瘤可以解除肿瘤患者的免疫抑制状态,促进患者免疫功能。结论:CT引导下^(125)I粒子植入治疗纵隔淋巴结转移,具有手术创伤小、近期疗效显著、安全性好、可行性高等优点,并改善晚期肿瘤患者的免疫功能,具有重要应用价值,值得临床进一步推广应用。

Purpose： To observe the efficacy of CT guided radioactive ^125I particles implantation in treatment of mediastinal lymph node metastases. Methods： Thirty-two patients with mediastinal metastatic lymph nodes received CT-guided radioactive ^125I particles implantation therapy. The regular CT scan was conducted after therapy to observe the control of the lesion, which determine the recent curative effect. Activity of T cells and natural killer cells （NK cells） were tested before and after operation to observe the immune function changes. Results： Thirty-two cases of mediastinal lymph node metastases were successfully completed ^125I radioactive particles implantation. The occurrence rate of the complications such as mild bleeding, pneumothorax, hemoptysis, and mild fever were 21.9%, 12.5%, 18.8%, and 25% respectively. The local control efficiency of 2 months, 4 months, 6 months after operation were： 81.2%, 90.6%, and 84.4%. The levels of CD4 ^＋, CD4^＋/CD8^＋ and NK cell on 14d, 21d and 28d after operation were elevated obviously when compared with that before operation, the difference was with statistical significant （P〈0.05）. Conclusion： CT-guided ^125I radioactive particles implantation in treating metastatic tumor of mediastinal lymph nodes has reliable curative effect and safety. Further application and study are needed to be done.