携^(125)I粒子敷贴式营养管治疗食管癌术后吻合口复发

Application of the Nutrition Tube Loaded with ^(125)I Seed for the Treatment of Postoperative Anastomotic Recurrence of Esophageal Carcinoma

目的初步评价携^(125)I粒子敷贴式营养管治疗食管癌术后吻合口复发的可行性和安全性。方法搜集2019年11月至2020年10月12例(男9例,女3例,平均年龄63.25岁,Karnofsky评分45.83分)食管癌外科术后局部复发合并Neuhaus分级Ⅲ~Ⅳ级患者,采用经鼻介入插管技术开通食管恶性梗阻段并置入携^(125)I粒子敷贴式营养管进行肠内营养和近距离放疗。记录技术成功率,并发症;计算机三维治疗计划系统(TPS)计算肿瘤吸收剂量,监测术后体外辐射剂量率;6~8周评价患者Karnofsky评分、Neuhaus分级吞咽困难和肿瘤最大径。结果所有患者均顺利完成携^(125)I粒子敷贴式营养管置入,技术成功率100.00%,术中2例患者少量出血,无感染、穿孔、大出血等严重并发症。TPS计算肿瘤平均吸收剂量54.48 Gy,术后即刻距离前胸体表30.00 cm、60.00 cm、90.00 cm辐射剂量率为60.94、16.54、8.74μSv/h。术后6~8周Karnofsky评分、Neuhaus分级均较术前明显改善(Z=-3.10,P=0.002;Z=-3.08,P=0.002),肿瘤最大径明显缩小(术前2.75 cm vs.术后1.80 cm,t=5.50,P=0.000)。结论携^(125)I粒子敷贴式营养管治疗食管癌术后吻合口复发安全可行,适合县级医院推广。

Objective To evaluate the feasibility and safety of the nutrition tube loaded with ^(125)I seeds for the treatment of postoperative anastomotic recurrence of esophageal cancer.Methods From November,2019 to October,2020,12 patients(mean 63.25 years old,9 males and 3 females,Karnofsky score 45.83,Neuhaus gradeⅢ/Ⅳ)with local recurrence of esophageal cancer underwent the interventional catheterization,and then the nutrition tube loaded with ^(125)I seeds was implanted for the enteral nutrition and brachytherapy.The technical success rate,complications,TPS calculation of tumor absorbed dose,and postoperative in vitro radiation dose rate were recorded.Karnofsky score,Neuhaus dysphagia and maximum tumor diameter were evaluated at 6-8 weeks.Results All patients completed the implantation of the nutrition tube with ^(125)I seeds adsorbed,which means a technical success rate of 100.00%.There were no serious complications such as infection,perforation,massive hemorrhage and so on,except that 2 patients had a small amount of bleeding.TPS calculated that the average tumor absorbed dose was 54.48 Gy.The radiation dose rate at 30.00 cm,60.00 cm,90.00 cm diameter from the anterior chest surface were 60.94,16.54 and 8.74μSv/h respectively.After 6-8 weeks,the Karnofsky score and Neuhaus grade were significantly changed(Z=-3.10,P=0.002;Z=-3.08,P=0.002,respectively),and the maximum diameter of the tumor was significantly reduced(preoperative 2.75 cm vs 1.80 cm,P=0.000).Conclusion It is a safe and feasible method of the placement of the nutrition tube loaded with ^(125)I seeds to treat postoperative anastomotic recurrence of esophageal cancer,which is suitable for promotion in county hospitals of China.