CAJ | 학술논문

目的：探讨肝癌TACE术后残存病灶的判断方法，125 I放射粒子治疗疗效及疗效检测方法。方法28例接受过1～5次TACE术治疗的肝癌患者共37个病灶，残存病灶确定方式为强化CT扫描10例，强化MRI 8例，PET‐CT 6例，肝动脉造影4例。根据治疗计划系统Brachy Interstitial‐Therapy Planning System （TPS）制订治疗计划，确定放射粒子数量及位置，肿瘤靶区超出肿瘤影像学边界0．5～1．0cm ，行C T引导下125 I放射粒子植入治疗残存病灶，定期检测血清AFP变化并与影像学结果做对比。结果强化CT、强化MRI 、PET‐CT、肝动脉造影均可确定肿瘤残存。28例患者37个病灶，均按计划完成治疗，分别于术后2、4、6、12月复查C T ，肿瘤局部控制有效率依次是：100％（37／37）、100％（37／37）、90．9％（36／37）、81．8％（34／37），血清AFP变化并与影像学结果高度一致。结论强化CT和MRI检查是判定肝癌TACE术后残存的首选方法，125 I放射粒子治疗残存病灶是有效的，AFP检测是125 I放射粒子治疗后有效的疗效判断方法。
목적：탐토간암TACE술후잔존병조적판단방법，125 I방사입자치료료효급료효검측방법。방법28례접수과1～5차TACE술치료적간암환자공37개병조，잔존병조학정방식위강화CT소묘10례，강화MRI 8례，PET‐CT 6례，간동맥조영4례。근거치료계화계통Brachy Interstitial‐Therapy Planning System （TPS）제정치료계화，학정방사입자수량급위치，종류파구초출종류영상학변계0．5～1．0cm ，행C T인도하125 I방사입자식입치료잔존병조，정기검측혈청AFP변화병여영상학결과주대비。결과강화CT、강화MRI 、PET‐CT、간동맥조영균가학정종류잔존。28례환자37개병조，균안계화완성치료，분별우술후2、4、6、12월복사C T ，종류국부공제유효솔의차시：100％（37／37）、100％（37／37）、90．9％（36／37）、81．8％（34／37），혈청AFP변화병여영상학결과고도일치。결론강화CT화MRI검사시판정간암TACE술후잔존적수선방법，125 I방사입자치료잔존병조시유효적，AFP검측시125 I방사입자치료후유효적료효판단방법。
Objective To explore the methods for judging the residual foucus of hepatocellular carcinoma after transcath‐eter arterial chemoemblization (TACE) as well as for measuring the postoperative effectiveness of radioactive particle 125 I implantation in treating the residual lesions .Methods A total of 37 foci were found in 28 patients treated with TACE for 1~5 times .The methods for determining residual lesions were the enhanced CT for 10 cases ,the enhanced MRI for 8 ca‐ses ,PET‐CT for 6 cases ,and hepatic arteriography for 4 cases ,respectively .Pre-operative plan was made according to Brachy Interstitial‐Therapy Planning System to determine the amount and location of radioactive particle implantation .The target zone should be exceeded 0 .5~1 .0 cm from the tumor zone ,in which the radioactive particle 125 I was implanted un‐der the guidance of CT for the therapy of residual lesions .Meanwhile ,the serum level of AFP was regularly tested and compared with imaging results .Results All of the the enhanced CT ,enhanced MRI ,PET‐CT ,and hepatic arteriography can determine the residual tumors .28 patients with 37 lesions were duly accepted the treatment in line with the plan and re‐examined with CT scan at 2 ,4 ,6 ,and 12 months ,respectively .The local tomor control rates were 100% (37/37) , 100% (37/37) ,90 .9% (36/37) ,81 .8% (34/37) .The serum AFP and imaging were highly consistent .Conclusion The preferred methods to determine the residual lesions after TACE were the enhanced CT and MRI ,125 I seed implantation for therapy of residual lesions was effective .The serum level of AFP was the effective method to judge the efficacy of residual lesions treated with 125 I seed implantation .