CT引导下纵隔淋巴结转移瘤125I放射性粒子植入穿刺入路及技巧

CT-guided radioactive I seeds implantation for mediastinal lymph node metastases: discussion on its puncture approach and skills

目的探讨纵隔淋巴结转移瘤125I放射性粒子植入治疗的穿刺路径及辅助技术。方法对2015年7月至2019年7月共16例肺癌纵隔淋巴结转移瘤放射性125I治疗病例进行回顾分析,探讨其穿刺路径及相关辅助技术,总结相关经验。结果 16例纵隔淋巴结转移瘤共20个病灶均顺利完成CT引导下125I放射性粒子植入治疗,穿刺路径分为经胸骨旁/椎旁入路(8例)、经胸骨入路(4例)、经胸骨上入路(2例),经胸椎入路(1例)、经胸膜腔入路(1例,人工气胸技术),术后无严重并发症。术后中位随访时间为9个月。疗效评价完全缓解(CR)10例(62.5%),部分缓解(PR)1例(6.2%),疾病稳定(SD)3例(18.8%),疾病进展(PD)2例(12.5%)。结论采用合适的穿刺路径及辅助技术是CT引导下纵隔淋巴结转移瘤125I放射性粒子植入治疗成功的重要因素。

Objective To discuss the puncture route and auxiliary technology of radioactive 125I seeds implantation in treating mediastinal lymph node metastases. Methods The clinical data of a total of 16 patients with mediastinal lymph node metastases from lung cancer, who were treated with radioactive 125I seeds implantation during the period from July 2015 to July 2019, were retrospectively analyzed. The practical puncture pathways and related auxiliary techniques were discussed, and the relevant experience was summarized. Results A total of 20 lesions were detected in the 16 patients, and successful CT-guided radioactive 125I seeds implantation was accomplished for all the 20 lesions. The puncturing pathways included trans-parasternal/paraspinal approach(n=8), trans-sternal approach(n=4), trans-suprasternal approach(n=2),trans-thoracic vertebra approach(n=1), and trans-pleural cavity approach(n=1, employing artificial pneumothorax technique). No Severe postoperative complications occurred. The median follow-up time was 9 months.Complete remission(CR) was achieved in 10 patients(62.5%), partial remission(PR) in one patient(6.2%),stable disease(SD) in 3 patients(18.8%), and progression disease(PD) in 2 patients(12.5%). Conclusion The appropriate puncture route and reliable auxiliary technique are the important factors for ensuring a successful CT-guided radioactive 125I seeds implantation in treating mediastinal lymph node metastases.