CAJ | 학술논문

目的观察B型超声（B超）引导下经皮穿刺125I粒子植入姑息性治疗溶骨性骨转移瘤的疗效。方法对2011年2月至2013年12月收治的18例晚期肿瘤患者的溶骨性骨转移瘤采用B超实时引导经皮穿刺植入125I粒子，术前、术后3 d以及术后1个月根据视觉模拟评分法（VAS）对疼痛评分。所有治疗病灶术后1个月复查CT检测肿瘤大小变化，观察粒子分布情况，必要时重复治疗。根据CT结果，按实体瘤的疗效评价标准（RECIST）评价疗效。结果18例患者进行33次手术，术后3 d局部疼痛较术前已有明显改善，与术前VAS比较P=0.000，差异有统计学意义。术后1个月疼痛仍能较好控制，P=0.000，差异有显著统计学意义。末次手术后1个月与基线相比观察疗效：CR 0例（0%），PR 11例（61.1%），SD 6例（33.3%），PD 1例（5.6%），局部控制率（CR+PR）61.1%。无严重的放疗并发症。结论 B超引导简便，可重复性好，能安全、有效地引导经皮穿刺125I粒子植入近距离放射治疗溶骨性骨转移瘤，在不采用治疗计划系统（TPS）的情况下，也能获得较好的局部控制率，疼痛缓解显著。
목적관찰B형초성（B초）인도하경피천자125I입자식입고식성치료용골성골전이류적료효。방법대2011년2월지2013년12월수치적18례만기종류환자적용골성골전이류채용B초실시인도경피천자식입125I입자，술전、술후3 d이급술후1개월근거시각모의평분법（VAS）대동통평분。소유치료병조술후1개월복사CT검측종류대소변화，관찰입자분포정황，필요시중복치료。근거CT결과，안실체류적료효평개표준（RECIST）평개료효。결과18례환자진행33차수술，술후3 d국부동통교술전이유명현개선，여술전VAS비교P=0.000，차이유통계학의의。술후1개월동통잉능교호공제，P=0.000，차이유현저통계학의의。말차수술후1개월여기선상비관찰료효：CR 0례（0%），PR 11례（61.1%），SD 6례（33.3%），PD 1례（5.6%），국부공제솔（CR+PR）61.1%。무엄중적방료병발증。결론 B초인도간편，가중복성호，능안전、유효지인도경피천자125I입자식입근거리방사치료용골성골전이류，재불채용치료계화계통（TPS）적정황하，야능획득교호적국부공제솔，동통완해현저。
Objective To assess the effect of ultrasound-guided percutaneous 125I seed implantation for the treatment of osteolytic metastases. Methods From February 2011 to December 2013, a total of 18 patients with advanced cancer complicated by osteolytic metastases received ultrasound-guided percutaneous implantation of 125I seeds. According to visual analog score (VAS) the pain was estimated before and 3 days as well as one month after the treatment. One month after the treatment follow-up CT scan was performed in all patients to check the tumor size and the distribution of 125I seeds, and the therapy was repeated if necessary. The efficacy was evaluated according to Response Evaluation Criteria in Solid Tumors (RECIST). Results A total of 33 times of procedure were carried out in the 18 patients. Three days after the treatment, local pain was obviously relieved in all cases. Compared with preoperative VAS, the postoperative VAS was significantly improved (P=0.000). The pain was well controlled even one month after the treatment (P=0.000). One month after the last treatment the complete remission (CR) rate was 0% (n=0), partial remission (PR) rate 61.1% (n=11), stable disease (SD) 33.3% (n=6) and progress disease (PD) 5.6% (n=1), and local control rate (CR+PR) was 61.1%. No severe brachytheray-related complications occurred. Conclusion Ultrasound-guided percutaneous 125I seed implantation brachytherapy is technically simple and repeatable, it can safely and effectively guide the performance of percutaneous 125I seed implantation for the treatment of osteolytic metastases. Even in the circumstance of not using TPS, this technique can also obtain satisfactory local control rate and significant pain relief.