许凯豪,焦德超,韩新巍,黄元豪,朱明,张庆辉,张全会.125I粒子敷贴式鼻饲营养管用于食管癌恶性梗阻[J].中国介入影像与治疗学,2021,18(2):69-73
125I粒子敷贴式鼻饲营养管用于食管癌恶性梗阻
Nasal feeding nutrient tube loaded with 125I seed for malignant obstructive esophageal carcinoma
投稿时间:2020-08-13  修订日期:2020-11-17
DOI:10.13929/j.issn.1672-8475.2021.02.002
中文关键词:  食管肿瘤  介入治疗  125I粒子
英文关键词:esophageal neoplasms  interventional therapy  125I seed
基金项目:河南省教育厅高等学校重点科研项目(20A320024)。
作者单位E-mail
许凯豪 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
焦德超 郑州大学第一附属医院放射介入科, 河南 郑州 450052 jiaodechao007@126.com 
韩新巍 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
黄元豪 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
朱明 郑州大学第一附属医院放射介入科, 河南 郑州 450052  
张庆辉 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  
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中文摘要:
      目的 观察自制125I粒子敷贴式鼻饲营养管用于治疗食管癌恶性梗阻的可行性和安全性。方法 对14例经病理证实的食管癌并伴Ⅲ~Ⅳ级吞咽困难高龄患者行DSA引导下125I粒子敷贴式鼻饲营养管置入术,使125I粒子完全覆盖肿瘤段上下各2 cm行近距离放射治疗;观察技术成功率、临床治疗成功率、手术时间、肿瘤吸收剂量[D90(90%肿瘤体积所接受的剂量)]、有无核素脱落、术后并发症及肿瘤控制情况,并比较术前与术后6~8周Karnofsky评分及Neuhaus吞咽困难分级差异。结果 对所有患者均成功置入125I粒子敷贴式鼻饲营养管,技术成功率100%(14/14);手术时间(27.37±4.82)min。临床治疗成功率85.71%(12/14),D90为(52.19±6.64)Gy。9例(9/14,64.29%)患者诉治疗期间胸骨后间断性疼痛,可耐受。未发生核素脱落及其他并发症,肿瘤局部控制率为92.86%(13/14)。术后6~8周Karnofsky评分(t=-2.75,P=0.01)及Neuhaus分级(Z=9.72,P<0.01)均较术前明显改善。结论 125I粒子敷贴式鼻饲营养管制作及置入简单、便捷,可同时实现近距离放射治疗和胃肠营养。
英文摘要:
      Objective To observe the efficacy and safety of nasal feeding nutritional tube loaded with 125I seeds for malignant obstruction of esophageal carcinoma. Methods Totally 14 elderly pathologically confirmed esophageal carcinoma patients with dysphagia grade Ⅲ-Ⅳunderwent DSA-guided implantation of nasal feeding nutrient tube loaded with 125I seeds. 125I seeds were put completely covered the tumors and the upper and lower segments more than 2 cm to perform brachytherapy. The technical success rate, clinical treatment success rate, operation time and absorbed irradiation dose of tumor (D90 [dose received for 90% of tumor volume]) were calculated, and the nuclides fall off or not, postoperative complications and tumor control were observed and recorded. Karnofsky scoring and Neuhaus dysphagia grading were compared before and 6-8 weeks after operation. Results Nasal feeding nutritional tubes loaded with 125I seeds were successful placed in all patients, the technical success rate was 100% (14/14), the operation time was (27.37±4.82) min, the clinical treatment success rate was 85.71% (12/14) and D90 was (52.19+6.64)Gy.Nine patients (9/14, 64.29%) had intermittent retrosternal pain during treatment but could tolerate. No radionuclide shedding nor other complications occurred. The local response rate of tumor was 92.86% (13/14). Both Karnofsky score (t=-2.75,P=0.01) and Neuhaus grade (Z=9.72, P<0.01) were significantly improved 6-8 weeks after the operation compared with those before operation. Conclusion The manufacture and placement of nasal feeding nutritional tube loaded with 125I seed was simple and convenient, being able to realize gastrointestinal nutrition and brachytherapy at the same time.
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