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目的探讨CT引导下125I放射性密封籽源植入治疗脑部肿瘤的操作方法、安全性及疗效。方法回顾分析22例经CT平扫及增强扫描确诊的脑内肿瘤,包括脑胶质瘤5例,脑胶质瘤术后复发6例,单发脑转移瘤9例,脑膜瘤2例。治疗前行CT引导下经皮穿刺快速病理证实,待病理结果后即刻行CT引导下经皮穿刺组织间植入125I放射性密封籽源4~16粒,125I放射性密封籽源的放射性活度为26、30、33Mbq/颗,籽源放射性总活度为120~480Mbq,籽源间距为1~1.5cm。穿刺点均为1处,调整进针方向2~5次。结果22例中随访1月以上22例,2月以上21例,3月以上20例,6月18例。1月随访22例中,肿瘤直径缩小11例,无变化10例,增大1例;2月随访21例中,肿瘤直径缩小14例,无变化4例,增大3例;3月随访20例中,肿瘤直径缩小15例,无变化2例,增大3例;6月随访18例中,肿瘤直径缩小14例,无变化2例,增大2例。22例中治疗前有明显神经定位体征16例,各种症状21例,其中精神症状1例,随访中症状减轻19例。脑水肿减轻14例,无变化4例,加重0例。治疗4月后死亡1例。结论经皮穿刺组织间植入125I放射性密封籽源治疗脑内肿瘤可使瘤体明显缩小,水肿减轻,症状不同程度缓解,效果肯定。CT引导下植入准确,相对安全。
Objective To investigate the operation, safety and efficacy of CT-guided 125I radioactive seed implantation in the treatment of brain tumors. Methods Twenty - two cases of brain tumors diagnosed by CT scan and enhanced scan were retrospectively analyzed, including 5 cases of glioma, 6 cases of recurrent brain glioma, 9 cases of solitary brain metastases and 2 cases of meningioma. Percutaneous puncture under CT guidance before the treatment of rapid pathology confirmed that immediately after the pathological results under CT-guided percutaneous needle puncture tissue implanted 125I radioactive seeds Seeds 4 to 16, radioactive seed 125I radioactive activity of 26 , 30,33Mbq / particle, the total radioactive seed source activity of 120 ~ 480Mbq, spacing of 1 ~ 1.5cm. Puncture point are 1, adjust the needle direction 2 to 5 times. Results 22 cases were followed up for more than 1 month in 22 cases, 21 cases in more than 2 months, 20 cases in March and 18 cases in June. Among the 22 cases who were followed up in January, the diameter of the tumor was reduced in 11 cases, no change in 10 cases, and the increase in 1 case. Among the 21 cases that were followed up in 2 months, the diameter of the tumor was reduced in 14 cases, unchanged in 4 cases and increased in 3 cases. In the cases, the diameter of the tumor was reduced in 15 cases, no change in 2 cases and an increase of 3 cases. Among 6 cases followed up for 18 cases, the diameter of the tumor was reduced in 14 cases, unchanged in 2 cases and increased in 2 cases. Twenty-two patients had obvious neurological signs before treatment, including 21 cases of various symptoms, including 1 case of psychotic symptoms and 19 cases of symptom relief during follow-up. 14 cases of cerebral edema relief, no change in 4 cases, aggravated in 0 cases. One patient died after 4 months of treatment. Conclusion The implantation of 125I radioactive seeds in the percutaneous puncture tissue treatment of brain tumors can significantly reduce the tumor, edema reduced, the symptoms relieved to varying degrees, the effect is affirmed. Implanted under CT guidance is accurate and relatively safe.