焦德超,雷钦宇,韩新巍,李宗明,王艳丽,张全会,王国胜.一体化可携带125I粒子双链鼻饲管用于治疗食管癌合并Ⅳ级吞咽困难[J].中国介入影像与治疗学,2020,17(9):518-522
一体化可携带125I粒子双链鼻饲管用于治疗食管癌合并Ⅳ级吞咽困难
Integrated gastrointestinal nutritional tube loaded with double 125I strands for brachytherapy of esophageal carcinoma with degree Ⅳ dysphagia
投稿时间:2019-06-25  修订日期:2020-07-03
DOI:10.13929/j.issn.1672-8475.2020.09.002
中文关键词:  食管肿瘤  吞咽障碍  碘同位素  近距离放射疗法
英文关键词:esophageal neoplasms  deglutition disorders  iodine isotopes  brachytherapy
基金项目:河南省医学科技攻关计划项目(SB201902015)、河南省高等学校重点科研项目(20A320024)。
作者单位E-mail
焦德超 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
雷钦宇 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
韩新巍 郑州大学第一附属医院放射介入科, 河南 郑州 450052 hanxinwei2006@163.com 
李宗明 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
王艳丽 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
张全会 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
王国胜 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
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中文摘要:
      目的 观察一体化可携带125I粒子双链鼻饲营养管用于治疗食管癌合并Ⅳ级吞咽困难的效果。方法 对10例食管癌合并Ⅳ级吞咽困难患者采用介入导管技术开通食管闭塞段,沿导丝送入新型一体化携125I粒子双链鼻饲营养管,使粒子段跨越食管闭塞段,行近距离放射治疗;统计技术成功率、临床成功率、术前与术后3天剂量学参数等指标;术后2个月根据Karnofsky评分、Neuhaus吞咽困难分级评价治疗效果,共随访半年观察疗效。结果 10例均顺利置入携125I粒子双链鼻饲营养管,技术成功率100%,临床成功率70%,无严重并发症。术前与术后90%肿瘤靶区(GTV)剂量(D90%)、GTV最小边缘剂量(mPD)、GTV接受200%及100%处方剂量的体积百分比(V200%、V100%)、适形指数(CI)及靶区外体积指数(EI)差异均无统计学意义(P均>0.05)。术后2个月Karnofsky评分、Neuhaus分级均较术前明显改善(P均<0.01),肿瘤局部控制率70%。随访半年,再发食管梗阻1例,死亡2例,7例未复发。结论 一体化可携带125I粒子双链鼻饲营养管可同时实现胃肠营养和近距离放疗,用于治疗食管癌合并Ⅳ级吞咽困难患者安全有效。
英文摘要:
      Objective To observe the effect of integrated gastrointestinal nutritional tube loaded with double 125I strands applied in esophageal cancer with grade Ⅳ dysphagia. Methods Interventional catheter technology was used to open the occlusive segment of esophagus in 10 patients with esophageal cancer and grade Ⅳ dysphagia. Then the new integrated tube was fed along the guide wire with 125I segment needs crossing the esophageal occlusion segment for brachytherapy. The technical success rate and clinical success rate were counted. The dosimetry parameters were recorded and compared before and 3 days after operation, while the therapeutic effect were estimated according to Karnofsky score and Neuhaus dysphagia grading 2 months after operation. The patients were followed up for 6 months to observe the prognosis. Results All 10 patients underwent successful tube insertion. The technical success rate was 100%, and the clinical success rate was 70%. No serious complication occurred. There was no statistically significant difference of 90% of gross tumor volume (GTV) received dose (D90%), GTV minimum peripheral dose (mPD), GTV received 200% and 100% of the prescribed dose volume percentage (V200%, V100%), conformal index (CI) nor external index (EI) before and after operation (all P>0.05). Karnofsky score and Neuhaus grading were significantly improved 2 months after operation (both P<0.01), and the local tumor control rate was 70%. During 6 months' follow-up, dysphagia reoccurred in 1 case, 2 cases died, while no relapse was found in 7 patients. Conclusion The integrated gastrointestinal nutritional tube loaded with double 125I strands can achieve gastrointestinal nutrition and brachytherapy at the same time,which is effective and safe for treating esophageal cancer and grade Ⅳ dysphagia.
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