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目的评价 CT 导向下~(125)I 粒子植入术治疗肝癌肝移植术后复发及肝外转移瘤的临床价值。方法肝癌肝移植术后复发及肝外转移瘤患者11例行~(125)I 粒子植入术共33人次,年龄35～68岁,中位年龄56岁。所有患者病灶总数为45个,平均每人4.09个病灶,病灶平均直径为2.5 cm。术前采用治疗计划系统(TPS)计算布源,术中将活度为30 MBq 的~(125)I 粒子在 CT 导向下植入肿瘤病灶内。粒子按照0.5～1.0 cm 平面插植。肿瘤周边匹配剂量(MPD)100～150 Gy,每个患者植入粒子数10～100颗不等。结果 45个病灶,完全缓解(CR)17个;部分缓解(PR)20个;无变化(NC)7个;进展(PD)1个。总有效率为82.2%。术中1例出现气胸,肺压缩在30%以内,经保守治疗好转,手术中少量出血者3例;术后1周痰中带血,体温升高者5例。2个月随访过程中发生粒子移位2例;白细胞下降2例,程度较轻。未见大出血、胆汁瘘、胰瘘等严重并发症。结论 CT 导向下~(125)I 粒子植入术治疗肝癌肝移植术后复发及转移瘤疗效确切,创伤小,并发症少。
Objective To evaluate the clinical value of CT guided 125 I seed implantation in the treatment of recurrence and extrahepatic metastasis of liver cancer after liver transplantation. Methods Totally 11 patients with ~ (125) I seed implantation for liver cancer recurrence after liver transplantation and extrahepatic metastases were aged 35 to 68 years with a median age of 56 years. The total number of lesions in all patients was 45, with an average of 4.09 lesions per person, with an average lesion diameter of 2.5 cm. The cloth source was calculated preoperatively with a TPS, with ~ (125) I particles with an activity of 30 MBq implanted into the tumor lesion under CT guidance. Particles in accordance with 0.5 ~ 1.0 cm plane implants. Tumor peripheral matching dose (MPD) 100 ~ 150 Gy, each patient implanted particles ranging from 10 to 100. Results There were 45 lesions with 17 complete remission (CR), 20 partial remissions (PR), 7 no change (NC) and 1 progress (PD). The total effective rate was 82.2%. One case had pneumothorax and pulmonary compression within 30%. After conservative treatment, 3 cases had a small amount of bleeding during operation. One case had bloody sputum after operation and 5 cases had elevated body temperature. 2 months follow-up occurred during the particle shift in 2 cases; leukopenia in 2 cases, to a lesser extent. No major bleeding, bile fistula, pancreatic fistula and other serious complications. Conclusion CT-guided ~ (125) I particle implantation for liver cancer recurrence and metastasis after liver transplantation exact effect, less trauma, fewer complications.