CAJ | 학술논문

目的探讨CT引导下经皮穿刺125I放射性粒子植入治疗纵隔转移性淋巴结的技术方法、安全性及临床价值.方法应用125I放射性粒子组织间种植治疗纵隔淋巴结转移患者8例,所有患者采用前路进针途径穿刺,按照病灶与体表穿刺点的位置设定CT机架的角度,采用多方位重组技术及平头针芯捻压分离主动脉、上腔静脉间隙进针法植入125I放射性粒子.疗效评价采用术后治疗计划系统(TPS),验证放射性粒子种植后剂量分布,观察治疗后患者局部压迫症状(气短、咳嗽、吞咽困难等)的改善情况及粒子植入术后2个月靶淋巴结的局部反应,并记录并发症情况.结果植入术后粒子覆盖率为(93.5 ±1.5)％.术后2个月复查,其中完全缓解(CR)3例,部分缓解(PR)4例,病灶稳定(SD)1例.5例气短、4例咳嗽和吞咽困难等局部压迫症状均有不同程度减轻,未出现头颈部及上肢水肿.术后无严重并发症发生；无大血管、气管、食管损伤,1例出现少量气胸.结论 CT引导下经皮穿刺组织间放射性粒子植入治疗纵隔4R区肿瘤转移性淋巴结,疗效肯定、安全可靠,为常规治疗局部压迫症状较严重的复杂部位淋巴结转移,提供了一种新的微创治疗方法.
목적 탐토CT인도하경피천자125I방사성입자식입치료종격전이성림파결적기술방법、안전성급림상개치.방법 응용125I방사성입자조직간충식치료종격림파결전이환자8례,소유환자채용전로진침도경천자,안조병조여체표천자점적위치설정CT궤가적각도,채용다방위중조기술급평두침심념압분리주동맥、상강정맥간극진침법식입125I방사성입자.료효평개채용술후치료계화계통(TPS),험증방사성입자충식후제량분포,관찰치료후환자국부압박증상(기단、해수、탄인곤난등)적개선정황급입자식입술후2개월파림파결적국부반응,병기록병발증정황.결과 식입술후입자복개솔위(93.5 ±1.5)％.술후2개월복사,기중완전완해(CR)3례,부분완해(PR)4례,병조은정(SD)1례.5례기단、4례해수화탄인곤난등국부압박증상균유불동정도감경,미출현두경부급상지수종.술후무엄중병발증발생；무대혈관、기관、식관손상,1례출현소량기흉.결론 CT인도하경피천자조직간방사성입자식입치료종격4R구종류전이성림파결,료효긍정、안전가고,위상규치료국부압박증상교엄중적복잡부위림파결전이,제공료일충신적미창치료방법.
Objective To investigate the technique,safety and clinical value of CT-guided percutaneous interstitial brachytherapy for metastatic carcinoma of lymph nodes in mediastinum.Methods Eight patients with metastatic carcinoma of lymph nodes in mediastinum were treated by CT-guided interstitial implant of radioactive seeds in our department.Anterior approach were performed on all cases,125I radioactive seeds were implanted by setting CT Gantry at an oblique angle,three-dimensional reconstruction with SCT and separation the narrow gap between aortic arch and superior vena cava with fiatscalp core.Dose distributions were checked by TPS after operation.The improvement in clinical symptoms and lymph node sizes were documented in order to investigate the therapeutic effects.Results The particle coverage rate was 93.5％ ± 1.5％.According to the CT scans two months later,3 patients ( 37.5％ ) had complete ablation,4 (50％) partial ablation,and 1 ( 12.5％ ) stable disease.Overall response rate (CR + PR) for this group of patients was 87.5％.The symptoms of all patients including shortness of breath (5 patients),cough (4 patients),dysphagia (4 patients) showed varying degree of improvement.No edema of head-and-neck and upper extremity was observed.There was no major vascular,tracheal and esophageal injury.A small amount of pneumothorax was observed in one patient.Conclusions CT-guided percutaneous interstitial brachytherapy,a minimally invasive procedure associated with favorable therapeutic results,is a promising technique for treatment of metastatic carcinoma of lymph nodes with local pressure symptoms which may not respond to conventional therapy.