摘要
目的探讨经导管动脉化疗栓塞术(transarterial chemoembolization,TACE)联合超声引导下125碘植入术(TACE-^(125)I)治疗肝细胞癌(hepatocellular carcinoma,HCC)伴有门静脉癌栓(PVTT)的安全性和有效性;并探讨单光子发射型计算机断层成像/电子计算机断层扫描(single-photon emission computed tomograph/computed tomograph,SPCET/CT)融合显像在发现、明确粒子漂移及精确部位等方面的价值。方法收集51例HCC伴PVTT患者,行TACE 4~7天后,在超声引导下对病灶部位进行^(125)I粒子植入术,粒子植入术后2~30 d行全身^(125)I扫描,并行局部SPECT-CT融合显像,统计粒子移位情况。结果①TACE-^(125)I治疗疗效明显,肝内病变控制率为86.3%;PVTT控制率为70.6%。胆红素水平在第4周增加,这表明在PVTT ^(125)I粒子植入后有益于影响靠近门静脉的小胆管。②SPECT-CT图像共计发现漂移粒子20粒,其中位于肝脏内者17粒,位于肝门区1粒,位于右侧肋间隙1粒,左侧肝包膜下1粒。CT图像共计发现漂移粒子25粒,误判漂移粒子5粒。结论TACE-^(125)I联合治疗肝细胞癌(HCC)伴有门静脉癌栓(PVTT)患者能有效控制肝脏病变进展,提高了患者生存期。SPECT-CT融合图像可以准确评价^(125)I粒子位置、浓聚范围及漂移情况,避免CT、X线等成像因密度和形态相近等因素的影响,弥补了平面显像重叠影像不足,值得临床推广使用。
Objective To investigate the safety and efficacy of transarterial chemoembolization(TACE)combined with ultrasound-guided 125 iodine implantation(TACE-^(125)I)in the treatment of patients with hepatocellular carcinoma(HCC)with portal vein carcinoma thrombosis(PVTT),and to explore the value of SPCET/CT fusion images in detecting and clarifying particle drift and precise sites.Methods 51 HCC patients with PVTT were collected,and ^(125)I particle implantation was performed on the lesion site under ultrasound guidance 4-7 days after hepatic artery chemoembolization,and whole-body ^(125)I scans were performed 2~30 d after particle implantation,and local SPECT-CT fusion imaging was performed in parallel to count patients with particle migration.Results 1.The efficacy of TACE-^(125)I treatment was obvious,with intrahepatic lesion control rate(86.3%),PVTT control rate(70.6%);we also observed an increase in bilirubin levels at week 4,which suggests that the small bile ducts near the portal vein were beneficially affected after PVTT ^(125)I particle implantation;2.A total of 20 drifting particles were found in SPECT-CT images,of which 17 were located A total of 20 drifting particles were found on SPECT-CT images,including 17 in the liver,1 in the hilar region,1 in the right intercostal space,and 1 in the left subhepatic envelope.25 drifting particles were found on CT images,and 5 drifting particles were misclassified.Conclusion TACE-^(125)I combination therapy for patients with hepatocellular carcinoma(HCC)with portal vein tumor thrombosis(PVTT)improve patient survival with minimal adverse events.It is also cheaper than sorafenib,which is currently the recommended therapy for patients with advanced HCC PVTT.With the help of whole-body scanning,the using of SPECT and CT image fusion can effectively evaluate the distribution of ^(125)I particles implanted in target organs.
作者
钟锦绣
李海峰
简艳
周琳
陈志军
ZHONG Jinxiu;LI Haifeng;JIAN Yan(Jiangxi Cancer Hospital,Nanchang,330029)
出处
《实用癌症杂志》
2021年第12期2028-2032,共5页
The Practical Journal of Cancer
基金
2019年江西省卫生计生委科技计划项目(编号:20195442)。
