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目的 探讨术中放射性粒子组织间种植治疗无法切除胰腺癌临床应用的可行性、手术方法和疗效。方法 13例无法切除胰腺癌患者行开腹~(125)I粒子植入治疗。术前根据治疗计划,确定粒子活度和种植粒子个数,肿瘤匹配周边剂量为65-110Gy,每颗粒子活度为0.40-0.5mCi。直视下或超声引导下插入粒子种植针,Mick粒子植入器植入~(125)I粒子,粒子植入数11-38颗。7例患者粒子植入前或后行胃肠或胆肠吻合术。1例患者术后加30Gy外放疗。1例患者术前支架治疗,1例患者术后行支架治疗。结果 随访1-12个月,9例患者术后1-3d疼痛即开始缓解,其中7例患者疼痛完全缓解,2例部分缓解,有效率100％。13例胰腺癌患者中CR4例,PR5例,PD4例。1例出现乳糜瘘,3例患者粒子移位到肝脏。没有出血、胰瘘和胰腺炎等并发症。结论 放射性粒子组织间种植治疗胰腺癌具有安全、有效、创伤小和并发症发病率低等优势,是一种较好的补救治疗手段,值得临床推广。
Objective To investigate the feasibility, operation method and curative effect of clinical application of intraoperative radioactive seed implantation in patients with unresectable pancreatic cancer. Methods Thirteen patients with unresectable pancreatic cancer underwent open 125 I seed implantation. Preoperative according to the treatment plan to determine the particle activity and the number of particles planted, tumor matching peripheral dose of 65-110Gy, particle activity per particle 0.40-0.5mCi. Under direct vision or ultrasound guided insertion of particle implantation needle, Mick particle implants implanted ~ (125) I particles, the number of particles implanted 11-38. Seven patients underwent gastrointestinal or cholangioenterostomy before or after implantation. One patient was treated with 30Gy external radiotherapy. One patient was treated with preoperative stent and one patient was treated with stent. Results The patients were followed up for 1-12 months. Nine patients had relieved pain 1-3 days after operation. Among them, seven patients were completely relieved of pain and two were partly relieved with 100% efficiency. Of the 13 patients with pancreatic cancer, 4 were CR, 4 were PR, and 5 were PD. One patient had chylous fistula and three patients had translocation to the liver. No bleeding, pancreatic fistula and pancreatitis and other complications. Conclusion Radiosperm tissue transplantation is safe and effective in the treatment of pancreatic cancer. It is a good remedy and worthy of clinical promotion.