CAJ | 학술논문

目的探讨复发性脑胶质瘤术中125Ⅰ粒子植入治疗的近期治疗效果及并发症.方法回顾性分析58例复发性脑胶质瘤患者资料,其中,23例患者行单纯手术,另外35例利用计算机三维治疗计划系统于术前或术中制定治疗计划,术中依据所制定的剂量,在肿瘤切除后的瘤床上植入125Ⅰ粒子,处方剂量为140～188 Gy.术后每2个月复查CT或MRI进行验证和质量评估,随访8～32个月,比较分析两组患者的肿瘤复发率、生存期及放射性并发症.结果单纯手术组中有20例复发,复发率为87.0％;有3例死于术后并发症.术中125Ⅰ粒子植入治疗组中有23例复发,复发率为65.7％;有5例死于术后并发症,4例发生顽固性脑水肿,3例发生放射性脑坏死.术中125Ⅰ粒子植入治疗组肿瘤复发时间[(97.5±15.3)周]明显长于单纯手术组[(62.5±13.6)周](t=9.21,P＜0.05),生存期[(60.3±7.1)周]亦明显长于单纯手术组[(43.1±5.5)周(t=13.03,P＜0.05).单因素变量分析结果显示,世界卫生组织肿瘤病理分级与肿瘤切除程度是影响患者生存率的独立因素.结论术中125Ⅰ粒子植入治疗可降低脑胶质瘤的复发率,有效增加复发性脑胶质瘤患者的生存时间.
목적 탐토복발성뇌효질류술중125Ⅰ입자식입치료적근기치료효과급병발증.방법 회고성분석58례복발성뇌효질류환자자료,기중,23례환자행단순수술,령외35례이용계산궤삼유치료계화계통우술전혹술중제정치료계화,술중의거소제정적제량,재종류절제후적류상상식입125Ⅰ입자,처방제량위140～188 Gy.술후매2개월복사CT혹MRI진행험증화질량평고,수방8～32개월,비교분석량조환자적종류복발솔、생존기급방사성병발증.결과 단순수술조중유20례복발,복발솔위87.0％;유3례사우술후병발증.술중125Ⅰ입자식입치료조중유23례복발,복발솔위65.7％;유5례사우술후병발증,4례발생완고성뇌수종,3례발생방사성뇌배사.술중125Ⅰ입자식입치료조종류복발시간[(97.5±15.3)주]명현장우단순수술조[(62.5±13.6)주](t=9.21,P＜0.05),생존기[(60.3±7.1)주]역명현장우단순수술조[(43.1±5.5)주(t=13.03,P＜0.05).단인소변량분석결과현시,세계위생조직종류병리분급여종류절제정도시영향환자생존솔적독립인소.결론 술중125Ⅰ입자식입치료가강저뇌효질류적복발솔,유효증가복발성뇌효질류환자적생존시간.
Objective To explore the therapeutic effect and complications of operation combined with 125Ⅰ seeds implantation in the treatment of brain glioma.Methods A retrospective analysis was underwent in 58 cases of recurrent cerebral glioma patients,among them,23 patients were treated with simple operation,35 cases were given treatment plans by three-dimensional treatment planning system in preoperation or intraoperation,and according to the does set in intraoperation,125Ⅰ seeds were implanted in the tumor bed after tumor resection with the prescription dose was 140-188 Gy.Verification and quality evaluation was performed every 2 months by CT or MRI.After 8-32 months follow-up,tumor recurrence rate,survival time and complications were compared between the two groups.Results There were 20 cases of recurrence in the simple operation group and the recurrence rate was 87％,3 patients died of postoperative complications.There were 23 cases of recurrence in the intraoperative 125Ⅰ seeds implantation group and the recurrence rate was 65.7％; 5 patients died of postoperative complications,4 cases of refractory cerebral edema,3 cases of radiation necrosis of the brain.The recurrence time in intraoperative 125Ⅰ implantation group [(97.5±15.3)weeks] was significantly greater than that in simple operation group[(62.5±13.6)weeks] (t=9.21,P＜0.05),the survival time[(60.3±7.1) weeks] was significantly longer than that in simple operation group [(43.1±5.5) weeks](t=13.03,P＜0.05).Conclusion 125Ⅰ seeds implantation treatment intraoperative could reduce glioma recurrence rate,effectively improve the survival time in recurrent glioma patients.