摘要
目的观察自制^(125)Ⅰ粒子敷贴式鼻饲营养管用于治疗食管癌恶性梗阻的可行性和安全性。方法对14例经病理证实的食管癌并伴Ⅲ~Ⅳ级吞咽困难高龄患者行DSA引导下^(125)Ⅰ粒子敷贴式鼻饲营养管置入术,使^(125)Ⅰ粒子完全覆盖肿瘤段上下各2 cm行近距离放射治疗;观察技术成功率、临床治疗成功率、手术时间、肿瘤吸收剂量[D90(90%肿瘤体积所接受的剂量)]、有无核素脱落、术后并发症及肿瘤控制情况,并比较术前与术后6~8周Karnofsky评分及Neuhaus吞咽困难分级差异。结果对所有患者均成功置入^(125)Ⅰ粒子敷贴式鼻饲营养管,技术成功率100%(14/14);手术时间(27.37±4.82)min。临床治疗成功率85.71%(12/14),D90为(52.19±6.64)Gy。9例(9/14,64.29%)患者诉治疗期间胸骨后间断性疼痛,可耐受。未发生核素脱落及其他并发症,肿瘤局部控制率为92.86%(13/14)。术后6~8周Karnofsky评分(t=-2.75,P=0.01)及Neuhaus分级(Z=9.72,P<0.01)均较术前明显改善。结论^(125)Ⅰ粒子敷贴式鼻饲营养管制作及置入简单、便捷,可同时实现近距离放射治疗和胃肠营养。
Objective To observe the efficacy and safety of nasal feeding nutritional tube loaded with ^(125)Ⅰ seeds for malignant obstruction of esophageal carcinoma.Methods Totally 14 elderly pathologically confirmed esophageal carcinoma patients with dysphagia gradeⅢ-Ⅳunderwent DSA-guided implantation of nasal feeding nutrient tube loaded with ^(125)Ⅰ seeds.^(125)Ⅰ seeds were put completely covered the tumors and the upper and lower segments more than 2 cm to perform brachytherapy.The technical success rate,clinical treatment success rate,operation time and absorbed irradiation dose of tumor(D90[dose received for 90%of tumor volume])were calculated,and the nuclides fall off or not,postoperative complications and tumor control were observed and recorded.Karnofsky scoring and Neuhaus dysphagia grading were compared before and 6-8 weeks after operation.Results Nasal feeding nutritional tubes loaded with ^(125)Ⅰ seeds were successful placed in all patients,the technical success rate was 100%(14/14),the operation time was(27.37±4.82)min,the clinical treatment success rate was 85.71%(12/14)and D90 was(52.19+6.64)Gy.Nine patients(9/14,64.29%)had intermittent retrosternal pain during treatment but could tolerate.No radionuclide shedding nor other complications occurred.The local response rate of tumor was 92.86%(13/14).Both Karnofsky score(t=-2.75,P=0.01)and Neuhaus grade(Z=9.72,P<0.01)were significantly improved 6-8 weeks after the operation compared with those before operation.Conclusion The manufacture and placement of nasal feeding nutritional tube loaded with ^(125)Ⅰ seed was simple and convenient,being able to realize gastrointestinal nutrition and brachytherapy at the same time.
作者
许凯豪
焦德超
韩新巍
黄元豪
朱明
张庆辉
张全会
XU Kaihao;JIAO Dechao;HAN Xinwei;HUANG Yuanhao;ZHU Ming;ZHANG Qinghui;ZHANG Quanhui(Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China)
出处
《中国介入影像与治疗学》
北大核心
2021年第2期69-73,共5页
Chinese Journal of Interventional Imaging and Therapy
基金
河南省教育厅高等学校重点科研项目(20A320024)。
