摘要
目的探讨CT引导下经皮穿刺对肺癌4R组纵隔淋巴结转移灶进行125I放射性粒子植入治疗的路径选择。方法选取2004年6月至2011年4月在我院接受治疗的经病理学明确诊断的伴有4R组纵隔淋巴结转移的晚期肺癌患者36例,其中10例患者出现上腔静脉综合征。对该组患者的淋巴结转移灶行CT引导下经皮穿刺125I放射性粒子植入治疗,采取自右前胸壁、右侧胸壁及右后胸壁三种进针路径进行粒子植入。术后6个月复查胸部CT,与粒子植入前比较肿瘤变化,按照国际标准判定疗效。随访自2004年12月至2011年10月。结果全部患者顺利完成粒子植入治疗,靶区接受的平均照射剂量为(236.8±12.9)Gy,D100(94.8±9.8)Gy,D90(139.6±11.6)Gy。植入术后6个月随访,有效率80.6%,行PET-CT检查的8例患者中有3例显示病灶活性完全消失。出现上腔静脉综合征的10例患者中症状及体征完全消失2例,好转6例。术中9例患者出现气胸,其中6例行胸腔闭式引流术,3例行胸腔穿刺抽气;6例患者出现肺内出血,其中2例伴有咳血,无进行性血胸,止血处理后症状消失,1个月后复查出血吸收。结论对4R组纵隔淋巴结转移癌进行CT引导下125I放射性粒子植入治疗,术中选择恰当的进针路径进行放射性粒子植入,使放射剂量分布合理提高疗效,并可减少穿刺损伤等并发症。
Objective To research and discuss the puncture paths in treating 4R mediastinal lymphnode metastasis of lung cancer by CT-guided percutaneous implantation of 125I radioactive seeds.Methods Select 36 patients with advanced cancer from Jun 2004 to Apr 2011,who had been pathology confirmed 4R mediastinal lymphnode metastasis.10 of them had appeared superior vena cava syndrome(SVCS).We treated the nidus by CT-guided percutaneous implantation of 125I radioactive seeds.There were 3 puncture paths(from right anterior chest wall,right side chest wall and right posterior chest wall respectively)for us to select in the operation.6 months after implantation,review the chest CT-scan and evaluate the effect according to the international standards.Follow-up from Dec 2004 to Oct 2011.Results All operations successfully completed.Average dose received by nidus was(236.8±12.9)Gy,D100(94.8±9.8)Gy,D90(139.6±11.6)Gy.The overall response rate was 80.6%.The PET-CT showed 3 patients′ nidus lost their bioactivity completely.Of 10 patients who had appeared SVCS,there were 2 with the symptoms disappeared completely and 6 got better.There were 9 pneumothorax in all operations and we treated by closed drainage of pleural cavity(6 cases)or thoracocentesis(3 cases),there were 6 pulmonary hemorrhage,we gave the hemostatic therapy.Conclusions Select puncture paths appropriately in treating 4R mediastinal lymphnode metastasis of lung cancer by CT-guided percutaneous implantation of 125I radioactive seeds is significant in completing implantation successfully,improving curative effect and avoiding severe complications.
出处
《中华临床医师杂志（电子版）》
CAS
2012年第16期4659-4662,共4页
Chinese Journal of Clinicians(Electronic Edition)
关键词
癌
非小细胞肺
淋巴转移
放射疗法
计算机辅助
进针路径
Carcinoma,none-small-cell lung
Lymphatic metastasis
Radiotherapy,computer-assisted
Puncture paths
