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晚期肺癌患者大多数肺功能较差,体外放射治疗和全身化疗后发生并发症的风险较高,患者难以接受。近年来,组织间永久性植入放射性粒子成为治疗肿瘤的新手段,植入125I粒子可以持续释放低能量γ射线,破坏肿瘤细胞的DNA双链结构,但对正常组织的损伤小,从而达到治疗目的[1]。此方法在晚期肺癌治疗中的应用越来越广泛,且易被接受,自2009年5月至2011年10月,我院采用125I粒子植入治疗了18例晚期肺癌患者,取得了良好的治疗效果,现将结果报道如下。
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术后一周,所有患者的气急症状均有不同程度的减轻,术后两周评定气促指数,其中,0级3例、1级9例、2级4例、3级2例。
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18例患者术后30 d行纤支镜和CT复查,结果发现,阻塞的支气管管腔扩大者16例(图 1);15例合并肺不张或阻塞性肺炎的患者术后30 d行胸部CT复查,结果发现,肺不张或阻塞性肺炎消失者13例(图 2)。经125I粒子植入术治疗后肿瘤直径的变化结果见表 1。
肿瘤最大径(cm) 术前 术后30 d 术后60 d 术后180 d 0 - 2 5 12 0-1 - 6 8 4 1-2 - 8 4 5 2-3 - 2 3 4 3-5 18 4 5 - 5-8 6 4 1 - >8 2 - - - 注:表中,“-”表示无此项数据。 表 1 18例晚期肺癌患者26个病灶经125I粒子植入治疗后肿瘤直径的变化结果(个)
随访180 d,仅1例死亡,死因为多器官功能衰竭。粒子植入术中均未出现严重并发症。
经纤支镜和经皮联合植入125I粒子治疗晚期肺癌气管狭窄的临床分析
The clinical analysis of 125I particles implantation by fibrobronchoscope and percutaneous in the treatment of tracheal stenosis of advanced lung cancer
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摘要:
目的 评价125I粒子植入治疗晚期肺癌中气管狭窄的临床疗效。 方法 收集晚期肺癌患者18例,将125I粒子经纤支镜插入病变气道进行植入治疗,每例患者植入粒子数为4~15粒。采用CT检查比较粒子植入前、术后30、60、180 d的肿瘤大小,并分析其临床症状变化。 结果 18例患者术后1周气急症状均减轻,30 d后有16例胸部CT检查显示支气管管腔扩大,13例阻塞性肺炎症状消失。随访期间所有患者均未出现严重并发症。 结论 125I粒子植入治疗晚期肺癌中气管狭窄的效果良好、操作安全,可作为治疗晚期肺癌气管狭窄的有效方法,并值得进一步推广。 Abstract:Objective To evaluate the clinical efficacy of 125I particles implantation in the treatment of tracheal stenosis due to advanced lung cancer. Methods Eighteen cases with end stage lung cancer were collected. 125I particles were implanted by inserting the bronchoscope into the pathological bronchial tubes of distal puncture. The number of 125I particles implanted ranged from 4-15. The tumor sizes were compared before and 30 d, 60 d, 180 d after the 125I particles implantation according to the examination of CT, and the clinical symptoms were studied. Results The symptoms of shortness of breath were relieved after 125I particles implantation. Thirty days follow-up after the therapy showed 15 cases of enlarged bronchial lumen, 13 cases of disappeared obstructive pneumonia symptoms, and no obvious complication occurred during the follow-up. Conclusion The implantation of 125I radioactive particles has a good effect for the tracheal stenosis in the treatment of advanced lung cancer; the therapy is safe and worth to be spread. -
Key words:
- Lung neoplasms /
- lodine radiosotopes /
- Brachytherapy /
- Tracheal stenosis
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表 1 18例晚期肺癌患者26个病灶经125I粒子植入治疗后肿瘤直径的变化结果(个)
肿瘤最大径(cm) 术前 术后30 d 术后60 d 术后180 d 0 - 2 5 12 0-1 - 6 8 4 1-2 - 8 4 5 2-3 - 2 3 4 3-5 18 4 5 - 5-8 6 4 1 - >8 2 - - - 注:表中,“-”表示无此项数据。 -
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