摘要
目的探讨CT引导下经皮椎体成形术(PVP)联合125I粒子植入治疗累及椎管的椎体转移瘤的安全性和疗效。方法 23例椎体转移性肿瘤患者,累及28节椎体,每例患者受累椎体1~2节,病变涉及颈椎4节、胸椎13节,腰椎11节。均可见椎体后壁破坏,其中12例13节肿瘤侵犯到硬膜外间隙。参照术前治疗计划系统(TPS),CT引导下,颈椎采用粒子针先行125I粒子植入,改变针道后再进行PVP;胸、腰椎则采用多支粒子针单、双侧穿刺于肿瘤后部植入125I粒子,再于椎体肿瘤的前、中部注入骨水泥完成PVP治疗,随访观察相关并发症及治疗效果。结果全部病例手术成功完成,植入粒子数目为4~30颗/节,骨水泥注入量为1~6 ml/节,20例(86.9%)术后患者疼痛缓解,5处(5/28,17.8%)发生骨水泥渗漏,1例神经孔渗漏引起神经根性疼痛,经治疗后好转。全组病例未发生脊髓损伤及放射性脊髓炎等严重并发症。结论 CT引导下PVP联合125I粒子植入治疗累及椎管的椎体转移瘤,能有效缓解患者的疼痛,控制肿瘤进展,骨水泥渗漏发生率低,临床应用安全。
Objective To evaluate the safety and efficacy of CT-guided percutaneous vertebroplasty （PVP） combined with 125 I-seed implantation for the treatment of metastatic vertebral carcinoma involving the spinal canal. Methods A total of 28 involved vertebrae were detected in 23 patients with metastatic vertebral carcinoma. Each patient had 1 - 2 diseased vertebrae. The lesions included cervical vertebra （n = 4）, thoracic vertebra （n = 13） and lumbar vertebra （n = 11）. Destroyed posterior vertebral wall was seen in all involved vertebrae. Thirteen vertebrae found in 12 patients showed involvement of the epidural space. According to treatment planning system （TPS） CT-guided implantation of 125 I seeds was carried out first for cervical lesions, which was followed by PVP. For the thoracic and lumbar lesions, unilateral or bilateral puncturing with several particle needles was employed to implant the 125I seeds, then, PVP with bone cement injection was performed. The complications and the clinical efficacy were analyzed. Results Successful operation was obtained in all patients. The number of implanted 125 I seeds ranged from 4 to 30 per vertebra, and the volume of injected bone cement was 1 - 6 ml per vertebra. After the operation the pain relief rate was 86.9% （n = 20）. The incidence of bone cement leakage was 17.8% （5/28）. One patient had radicular pain caused by neuropore leakage, which was relieved after medication. No serious complications, such as spinal cord injury or radiation myelitis, occurred. Conclusion CT-guided PVP combined with 125 I-seed implantation is effective and safe for the treatment of metastatic vertebral carcinoma involving the spinal canal. This therapy can effectively relieve the pain and control the deterioration of tumor, besides, the incidence of bone cement leakage is very low.
出处
《介入放射学杂志》
CSCD
北大核心
2014年第3期226-230,共5页
Journal of Interventional Radiology
