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目的探讨手术切除联合术中125I粒子组织间植入治疗食管癌的疗效和副作用。方法回顾性分析2004年10月至2009年9月61例中、晚期食管癌患者(盐城市第五人民医院32例,南京医科大学附属南京第一医院29例)采用手术切除联合术中125I粒子组织间植入或联合放疗治疗的临床资料。根据治疗方法不同,将61例患者分为两组,125I粒子植入组:31例[男21例,女10例;年龄(59.5±1.5)岁],采用手术切除+术中125I粒子组织间植入治疗;对照组:30例[男19例,女11例;年龄(60.1±1.6)岁],术后3～4周采用体外放射治疗。观察两组患者术前、术后白细胞(WBC)、血小板(PLT)、免疫球蛋白的变化,比较生存率、复发率和转移率。结果术后1个月、3个月和5个月,两组患者外周血WBC、PLT和免疫球蛋白均在正常范围内;两组间比较差异无统计学意义(P>0.05)。两组患者均获随访,随访时间1～5年。术后6个月125I粒子植入组患者行胸部X线片检查示:均未发现粒子移位。125I粒子植入组患者1年、3年和5年生存率均明显高于对照组(3年58.3%vs.42.8%,P<0.05;5年36.8%vs.26.6%,P<0.05),复发率(3年0%vs.6.7%,P<0.05;5年3.2%vs.13.3%,P<0.05)和转移率(3年12.9%vs.20.0%,P<0.05;5年16.1%vs.33.3%,P<0.05)明显低于对照组。结论手术切除结合125I粒子组织间植入治疗食管癌,方法简单、使用安全、副作用小,可提高食管癌患者的生存率。
Objective To investigate the efficacy and side effects of surgical resection combined with interstitial implantation of 125I seeds in the treatment of esophageal cancer. Methods A retrospective analysis of 61 patients with moderate or advanced esophageal cancer from October 2004 to September 2009 (32 patients in Yancheng Fifth People’s Hospital and 29 in Nanjing First Affiliated Hospital of Nanjing Medical University) were treated with surgical resection combined with intraoperative 125I particles. Clinical data for interstitial implantation or combined radiotherapy. According to different treatment methods, 61 patients were divided into two groups, 125 I seed implantation group: 31 cases [male 21, female 10; age (59.5 ± 1.5) years], surgical resection + intraoperative 125I particle interstitial tissue Implantation therapy; control group: 30 cases [male 19, female 11; age (60.1 ± 1.6) years], 3 to 4 weeks after surgery using external radiation therapy. The changes of white blood cells (WBC), platelets (PLT), and immunoglobulins before and after surgery were observed, and the survival rate, recurrence rate, and metastatic rate were compared. Results At 1 month, 3 months and 5 months after operation, the WBC, PLT and immunoglobulin in peripheral blood of both groups were within the normal range. There was no significant difference between the two groups (P>0.05). Both groups were followed up for 1 to 5 years. A chest X-ray examination of the 125I particle implanted group at 6 months postoperatively showed that no particle displacement was observed. The 1-year, 3-year, and 5-year survival rates of the 125I seed implantation group were significantly higher than those of the control group (58.3% vs. 42.8%, P<0.05 for 3 years, 36.8% vs. 26.6% for 5 years, P<0.05). The recurrence rate (3 years 0% vs. 6.7%, P <0.05; 5-year 3.2% vs. 13.3%, P <0.05) and metastatic rate (3 years 12.9% vs 20.0%, P <0.05; 5-year 16.1% (vs.33.3%, P<0.05) was significantly lower than the control group. Conclusion Surgical resection combined with 125I particle interstitial implantation for the treatment of esophageal cancer has the advantages of simple method, safe use and small side effects. It can improve the survival rate of patients with esophageal cancer.