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目的:探讨应用CT引导下n 125I放射性粒子植入治疗放射性碘难治性分化型甲状腺癌(RAIR-DTC)淋巴结转移的可行性，评估其安全性和有效性，从剂量学层面验证计算机三维治疗计划系统(TPS)在辅助n 125I粒子植入治疗淋巴结转移中的精确性。n 方法:回顾性分析2016年12月至2019年1月间北部战区总医院收治的17例RAIR-DTC伴淋巴结转移患者(男8例，女9例，中位年龄58岁)，患者行术前TPS计划设计、CT引导下穿刺及植入n 125I粒子，粒子活度为14.8~25.9 MBq，将术后验证的剂量学结果与术前计划对比，包括手术前后靶区体积和90%、100%大体肿瘤体积(GTV)接受的处方剂量(n D90、n D100)及GTV接受100%、150%处方剂量的体积百分比(n V100、n V150)、均匀性指数(HI)等剂量学参数，并于术后6个月复查CT，比较治疗前后转移淋巴结大小变化、甲状腺球蛋白(Tg)水平变化及并发症改善情况。疗效分为完全缓解(CR)、部分缓解(PR)、病灶稳定(SD)、疾病进展(PD)。采用配对n t检验或Wilcoxon符号秩检验分析数据。n 结果:17例患者共植入n 125I放射性粒子226颗，CR 1例，PR 10例，SD 4例，PD 2例。治疗前淋巴结转移灶最大径为1.40(0.65，3.05) cm，治疗6个月后为0.40(0.21，0.91) cm(n z＝-3.95，n P<0.05)；治疗前Tg为23.50(20.94，72.92) μg/L，治疗后6个月为8.90(3.20，40.22) μg/L(n z＝-5.009，n P0.05]，术后剂量参数n D100、n V150[(6 881.5±1 381.8) cGy与(58.5±18.4)%]均低于术前计划[(8 085.8±2 330.0) cGy与(66.5±17.7)%；n t值：8.913和3.032，均n P0.05)。n 结论:参照TPS术前计划行n 125I粒子植入治疗RAIR-DTC淋巴结转移可达到预期的剂量分布，短期肿瘤局部控制疗效确切，是一种安全有效的治疗方法。n “,”Objective:To evaluate the efficacy and safety of n 125I seeds implantation for lymph nodes metastasis (LNM) from radioactive iodine-refractory differentiated thyroid carcinoma (RAIR-DTC), and to verify the computer three-dimensional treatment planning system (TPS) from the dosimetry accuracy in assisting seeds implantation to treat LNM.n Methods:Retrospective analysis was performed on 17 RAIR-DTC patients with LNM admitted to the General Hospital of Northern Theater Command from December 2016 to January 2019 (8 males, 9 females, median age 58 years). All patients underwent preoperative TPS planning design, CT-guided puncture and n 125I seeds implantation (seed activity 14.8-25.9 MBq). The dosimetric results of postoperative validation were compared with those of preoperative planning, including the dosimetric parameters such as target volume before and after surgery and the dose received by 90% and 100% gross tumor volume (GTV) (n D90, n D100), the percentage received by 100% and 150% of the prescription dose (n V100, n V150), homogeneity index (HI). All patients underwent CT after 6 months to compare the LNM size, serum thyroglobulin (Tg) level, and the improvement of complications before and after treatment. Efficacies were divided into complete remission (CR), partial remission (PR), stable disease (SD), and progressive disease (PD). Paired n t test or Wilcoxon signed rank test were used to analyze the data.n Results:Among 17 patients, a total of 226 n 125I radioactive seeds were implanted. Among them, 1 achieved CR, 10 achieved PR, 4 were with SD, and 2 were with PD. The diameter of LNM was 1.40(0.65, 3.05) cm before treatment and was 0.40(0.21, 0.91) cm 6 months after treatment (n z=-3.95, n P<0.05). The Tg before treatment was 23.50(20.94, 72.92) μg/L and was 8.90(3.20, 40.22) μg/L 6 months after treatment (n z=-5.009, n P0.05). The postoperative dose parametersn D100 and n V150 ((6 881.5±1 381.8) cGy, (58.5±18.4)%) were both lower than those of preoperative plan ((8 085.8±2 330.0) cGy, (66.5±17.7)%; n t values: 8.913, 3.032, both n P0.05).n Conclusions:According to the TPS preoperative plan, n 125I seeds implantation for treating RAIR-DTC LNM can achieve the expected dose distribution, and the short-term tumor local control is effective. It is a safe and effective treatment method.n