^(125)I粒子植入治疗肺癌并发症的临床观察

Clinical observation of the complications caused by ^(125)I seed implantation brachytherapy for lung cancers

目的观察放射性^(125)I粒子植入治疗肺癌患者的并发症。方法回顾性分析2015年1月至2017年6月接受^(125)I粒子植入治疗的31例肺癌患者,观察气胸、出血、放射性肺炎、粒子游走、针道种植转移等并发症。结果 31例患者共进行粒子植入49例次,粒子植入治疗过程中发生气胸21例次(42.9%),其中14例经观察或抽气治疗,7例放置胸腔引流管好转;咯血3例次(6.1%);出血14例次(28.6%),其中2例引流200 mL血性液体,其余出血量2～20 mL。术后出现皮下气肿5例次(10.2%),痰中带血6例次(12.2%),发热1例次(2.0%),1例患者(2.0%)在粒子植入后发现2颗粒子游走至心脏;1例患者(2.0%)在粒子植入后4个月出现针道种植转移。所有并发症均经处理好转,未发生放射性肺炎、空气栓塞、手术相关死亡等并发症。结论 CT引导下^(125)I粒子植入治疗肺癌患者常见并发症为气胸、出血,少数病例发生针道种植转移、粒子游走,需要有效防治。

Objective To investigate the complications caused by ^（125）I seed implantation brachytherapy for the treatment of lung cancers. Methods The clinical data of a total of 31 patients with lung cancer, who received ^（125）I seed implantation brachytherapy during the period from January 2015 to June 2017 at Hebei Provincial People＇s Hospital, China, were retrospectively analyzed. The complications, including pneumothorax,bleeding, radiation pneumonia, migration of ^（125）I seed, metastatic implantation in puncture needle track, etc.,were documented and the results were analyzed. Results A total of 49 times of ^（125）I seed implantation procedure were carried out in 31 patients. During the course of seed implantation pneumothorax occurred in21 procedures（42.9%）, among these procedures the pneumothorax was improved after suction therapy in14 and after placement of thoracic drainage tube in 7. Hemoptysis occurred in 3 procedures（6.1%）;hemorrhage occurred in 14 procedures（28.6%）, and in 2 of these procedures 200 ml bloody fluid was collected through drainage and in the remaining 12 procedures the amount of bleeding was about 2-20 mL.After the treatment, the subcutaneous emphysema occurred in 5 procedures（10.2%）, sputum with blood in 6 procedures（12.2%）, fever in one procedure（2.0%）. In one patient（2.0%） migration of two ^（125）I seeds to the heart was observed after the implantation, and in another patient（2.0%） metastatic implantation in puncture needle track occurred four months after the implantation. All the above mentioned complications were improved after proper treatments. No radiation pneumonia, aeroembolism, or surgery-related death occurred. Conclusion In treating patients with lung cancer by using CT-guided ^（125）I seed implantation brachytherapy, the common complications are pneumothorax and bleeding. Metastatic implantation in puncture needle track and migration of ^（125）I seed can occur in a few patients, for which effective prevention measures and proper treatments are needed.