支气管镜引导下^(125)I粒子植入联合全身化疗治疗晚期中心型肺癌的疗效观察

Efficacy of bronchoscopy-guided ^(125)I seeds implantation combined with chemotherapy for advanced central type lung cancer

目的 探讨观察经电子支气管镜(electronic bronchoscopy,EB)植入^(125)I粒子联合全身化疗在晚期中心型肺癌治疗中的临床疗效和安全性。方法 收集2014年5月至2016年7月期间我科收治的66例Ⅲb~Ⅳ期中心型肺癌患者,将患者分为试验组和对照组。其中,试验组30例,行经EB植入^(125)I粒子联合全身化疗;对照组36例,行全身化疗。两组化疗方案选择均为吉西他滨联合顺铂方案,术后1、3、5个月随访并行EB和CT检查,按WHO标准判断有效率和不良反应:结果 试验组和对照组总体有效率分别为80.00%和50.00%,两组间差异有统计学意义(P<0.05)。试验组的咯血发生率高于对照组,差异有统计学意义(P<0.05)。两组的气胸、发热、骨髓抑制发生率比较,差异无统计学意义(P>0.05)。所有出现的不良反应均较轻,可控制。结论 经EB植入1251粒子联合全身化疗近期疗效好,是一种微创的、安全的治疗晚期中心型肺癌的方法。

Objective To explore the efficacy and safety of bronchoscopy-guided radioactive ^125I seeds implantation combination with chemotherapy for advanced central type lung cancer. Methods Sixty-six patients with central type lung cancer in stage Ⅲb or Ⅳ were enrolled in this study from May 2014 to July 2016. The patients were randomly divided into two groups, ie. bronchoscopy-guided seeds implantation combined with chemotherapy group （experimental group, n=30） and chemotherapy group （control group, n=36）. All patients accepted GP regimen （gemcitabine plus cisplatin） chemotherapy and were followed up by CT and electric bronchoscopy （EB） examination 1, 3, 5 months later. According to WHO unified standard, the efficacy and adverse effects were evaluated . Results In the experimental group and the control group, the response rate （complete response plus partial response） was 80.00% and 50.00%, respectively. There was significant difference between two groups （P〈0.05）. The incidence rate of hemoptysis in the experimental group was significantly higher than that in the control group （P〈0.05）, but there was no significant difference between the two groups in the incidence rate of pneumothorax, fever or bone marrow suppression （allP〉0.05）. All adverse reactions were light and could be controlled. Conclusions The short-term clinical efficacy is better in the bronchoscopy-guided seeds implantation combined with chemotherapy group. The bronchoscopy-guided seeds implantation combined with chemotherapy is a safe and minimally invasive treatment for advanced central type lung cancer.