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目的探讨~(125)Ⅰ粒子术中植入联合动脉灌注区域性化疗对晚期胰腺癌的治疗价值。方法对晚期胰腺癌患者行术中穿刺或切取活检明确病理诊断。~(125)Ⅰ粒子平铺于瘤床或瘤体内插植,动脉化疗泵经胃左动脉或胃网膜右动脉植入,远端置于肝总动脉或腹腔动脉干,必要时行胆肠和(或)胃肠吻合术。术后化疗方案为吉西他滨(1000 mg/m~2)联合氟尿嘧啶(5-Fu)(500 mg/m~2),每周1次,连续7周。结果所有7例患者平均植入放射性粒子42粒,平均剂量29.4 mCi。平均随访245d[(123～332)d],疼痛缓解率100%,肿瘤缩小4例,转移灶缩小、减少2例。糖链抗原19-9(CA19-9)水平全部降至正常。1例术后发生胰漏,行保守治疗而愈。结论 ~(125)Ⅰ放射性粒子术中植入联合动脉置管区域性灌注化疗适用于有手术指征的晚期胰腺癌,可有效缓解临床症状,改善患者生活质量。
Objective To investigate the therapeutic value of regional chemotherapy combined with intraarterial infusion of 125I seeds in the treatment of advanced pancreatic cancer. Methods The patients with advanced pancreatic cancer underwent either biopsy or biopsy during operation. ~ (125) Ⅰ particles tiled in the tumor bed or tumor implantation, arterial chemotherapy pump by the left gastric artery or the right gastric artery implantation, distal placed in the common hepatic artery or celiac artery, if necessary, gall bladder And / or gastrointestinal anastomosis. Postoperative chemotherapy was gemcitabine (1000 mg / m ~ 2) combined with 5-Fu (500 mg / m ~ 2) once a week for 7 weeks. Results All seven patients received an average of 42 radioactive particles, with an average dose of 29.4 mCi. The mean follow-up was 245 days (123 to 332 days). The pain relief rate was 100%, the tumor was reduced in 4 cases, the metastasis was reduced and decreased in 2 cases. Sugar chain antigen 19-9 (CA19-9) levels were all reduced to normal. One case of pancreatic leakage occurred after surgery, and more conservative treatment. Conclusion The regional perfusion chemotherapy with ~ (125) Ⅰ radioactive intraoperative implantation and arterial catheterization is suitable for advanced pancreatic cancer with surgical indications, which can effectively relieve the clinical symptoms and improve the quality of life of patients.