论文部分内容阅读
目的:探讨n 125I粒子气道覆膜支架在气管腺样囊性癌治疗中的疗效及安全性。n 方法:回顾性分析厦门医学院附属第二医院2014年12月至2017年7月收治的行n 125I粒子气道覆膜支架置入治疗的气管腺样囊性癌患者8例，对比治疗前后气促指数、管腔直径、管壁厚度、管壁周围病灶的变化，并观察并发症。n 结果:8例患者共成功置入n 125I粒子气道覆膜支架11枚（直筒型支架2枚，L型支架2枚，Y型支架7枚，共使用粒子243颗）。支架置入后2周内出现移位2例，后重新置入并固定，未再移位。中位支架置入时间为2.9（2.3，3.0）个月。治疗后的气促指数较术前明显下降（分别为0.1和3.4，n t=8.881，n P<0.01）；复查支气管镜，1例气道腔内肿瘤残余，其余7例气道腔内肿瘤完全消失，气道黏膜光滑、苍白、部分瘢痕形成（呈放疗后改变）；复查胸部CT，病变处管腔直径显著扩大（分别为13.1和3.3 mm，n t=-7.839，n P<0.01），管壁厚度明显缩小（分别为4.3和14.4 mm，n t=7.620，n P50%。中位随访时间为28.0（24.8，31.5）个月，1例2年内复发，2年无复发6例。随访期间，无死亡事件，未出现严重并发症。n 结论:125I粒子气道覆膜支架能有效扩张气管腺样囊性癌患者的气道、缓解气促症状，同时具有内放疗作用，疗效显著，安全性高，值得临床进一步探索观察。n “,”Objective:To explore the efficacy and safety of the covered airway stent loaded with n 125I seeds for the treatment of tracheal adenoid cystic carcinoma (TACC).n Methods:We retrospectively reviewed the clinical data from 8 patients with TACC who had received placement of the covered stent loaded with n 125I seeds between December 2014 and July 2017 in the endoscopic center of the Second Affiliated Hospital of Xiamen Medical College. We compared the difference in the dyspnea index, the diameter of the airway lumen, and the lesion surrounding the airway wall before and after treatment. The complications were also recorded during follow-up.n Results:Eight patients underwent successful placement of a total of 11 radioactive stents (2 straight-type stents, 2 L-shape stents, and 7 Y-shape stents, all loaded a total of 243 radioactive particles). Displacement of stents took place within 2 weeks in 2 patients, who were managed with re-stenting and fixation. No further displacement occurred during follow-up. The median time to stent removal was 2.9(interquartile range: 2.3,3.0) months. After stent placement, the dyspnea index was significantly decreased compared with pre-treatment level (mean: 0.1 vs. 3.4, n t=8.881, n P<0.001). Bronchoscopic re-assessment showed that the residual tumor within the airway was detected in only one patient and that the tumor completely disappeared in the remaining 7 patients. Treatment with stents loaded with radioactive particles yielded smooth and pale airway mucosa with formation of partial scar formation. Chest computed tomography re-assessment demonstrated significantly larger luminal diameter than that before treatment (mean: 13.1 mm vs. 3.3 mm, n t=-7.839, n P<0.001). The airway wall thickness was notably reduced after treatment (mean: 4.3 mm vs. 14.4 mm, n t=7.620, n P<0.001). The lesions surrounding the airway wall completely disappeared in 7 patients and decreased for more than 50% in a single patient. The median duration of follow-up was 28.0(interquartile range: 24.8,31.5) months. Recurrence of tumor was documented in a single case within 2 years. Six patients did not experience recurrence within the 2-year follow-up period. No death or severe complications were recorded during follow-up.n Conclusion:The n 125I radioactive stent is effective for dilating the stenotic airway and ameliorating the symptoms, and thus might be an effective and safe method for the treatment of TACC. Further studies that explore the efficacy of stents loaded with n 125I particles are needed.n