放射性粒子植入近距离照射治疗脊柱肿瘤的方法研究

Study on the Method of Implanting Radioactive Particles in Brachytherapy for Spinal Tumors

目的探讨使用放射性粒子植入近距离照射治疗脊柱肿瘤的方法、效果及预后。方法选取2018年1月—2019年7月收治的19例脊柱肿瘤患者为研究对象,患者肿瘤均出现转移,经活检病理确诊,所有患者均行125I粒子植入近距离照射治疗,其中2例肝癌转移者借助C型臂X线机植入粒子,1例S2~S3脊索瘤在切除后组织边缘后穿刺进针并植入粒子,16例结合术前CT影像经皮穿刺进展后植入粒子,观察患者的治疗情况及随访预后情况。结果所有粒子植入均顺利完成,期间未出现血管、神经及周围脏器损伤,术后未发生血肿、伤口感染;随访患者在植入后5~13 d起效,疼痛缓解,持续随访14例肿瘤生长得到抑制;1例术后11个月死于肝脏衰竭,2例死于多器官衰竭,其余患者均成活。结论对脊柱肿瘤,应用125I粒子植入近距离照射治疗的方式可有效缓解疼痛及延缓肿瘤生长,提高肿瘤远期生存率,值得推广。

Objective To investigate the methods,effects and prognosis of radiofrequency seeds placed in close-range irradiation for the treatment of spinal tumors.Methods A total of 19 patients with spinal tumors admitted from January 2018 to July 2019 were enrolled.The tumors were metastasized and confirmed by biopsy.All patients underwent 125I particle placement for brachytherapy,2 of which were treated.Hepatoma metastasis was implanted with particles by C-arm X-ray machine.One case of S2~S3 chordoma was inserted into the needle after the resected tissue edge,and the particles were placed.16 cases were combined with preoperative CT images and percutaneously inserted into the particles.Observe the patient's treatment and follow-up prognosis.Results All the particles were successfully placed.There were no vascular,nerve and peripheral organ injuries.No hematoma or wound infection occurred after operation.The follow-up patients took effect 5 to 13 d after implantation,and the pain was relieved.14 cases were followed up.Tumor growth was inhibited;1 patient died of liver failure 11 months after surgery,2 patients died of multiple organ failure,and the remaining patients survived.Conclusion For spinal tumors,the application of 125I particles in close-range irradiation can effectively alleviate pain and delay tumor growth,and improve the long-term survival rate of tumors.It is worthy of promotion.