目的探讨超声或CT引导下放射性125I粒子组织间植入治疗复发直肠癌的技术可行性、近期疗效和副反应。方法15例直肠癌术后盆腔复发患者,女4例,男11例。硬膜外麻醉,2例经阴道超声引导,13例CT引导,行放射性125I粒子植入术。肿瘤匹配周边剂量为90~110Gy,每颗粒子活度为0.50~0.70mCi,植入33~70颗。术后24~48h拍胸、盆腔X线片了解粒子是否发生移位。术后6例加三维适形放疗,4~6野/次,200~300cGy/次,5次/周,总剂量为4500~5000cGy,间隔4周。2例粒子治疗后加草酸铂、5-氟尿嘧啶和四氢叶酸化疗1个周期,随访3~15个月,根据CT扫描结果判断肿瘤大小。结果术后平均7天疼痛缓解,其中12例完全缓解,2例部分缓解,1例无变化,有效率93%(14/15)。9例肿瘤完全缓解,2例部分缓解,4例局部进展,局部控制率73%(11/15)。2例术后6个月和12个月时死于肺转移。1例1颗粒子移位至盆壁,随访12个月无症状。无治疗相关并发症和副作用发生。结论经超声或CT引导放射性125I粒子植入治疗复发直肠癌具有安全、微创、并发症发生率低和疗效肯定等优势,粒子治疗后应配合外放疗和全身化疗,有望进一步提高疗效。 Objective To investigate the technical feasibility, short-term curative effect and side effects of radioactive 125I interstitial implantation guided by ultrasound or CT in the treatment of recurrent rectal cancer. Methods Fifteen patients with pelvic recurrence after rectal cancer surgery, 4 were female and 11 were males. Epidural anesthesia, 2 cases of transvaginal ultrasound guidance, 13 cases of CT guidance, radioactive 125I particle implantation. Tumor matching peripheral dose of 90 ~ 110Gy, particle activity of 0.50 ~ 0.70mCi, 33 to 70 implanted. Patient 24 ~ 48h pat the chest, pelvic X-ray film to understand whether the particles shift. After operation, 6 cases were treated with three-dimensional conformal radiotherapy, 4 to 6 fields / time, 200 to 300 cGy / time, 5 times / week, and the total dose was 4500-5000 cGy at 4-week intervals. Two patients were treated with oxaliplatin, 5- fluorouracil and tetrahydrofolate chemotherapy for one cycle followed up for 3-15 months, and the tumor size was judged according to the CT scan results. Results The average postoperative pain relief was 7 days, of which 12 cases were completely relieved, 2 cases partially relieved, 1 case no change, the effective rate was 93% (14/15). Nine tumors were completely relieved, two partially relieved, and four locally advanced. The local control rate was 73% (11/15). Two patients died of lung metastases at 6 months and 12 months after operation. One case of one particle migrated to the pelvic wall and was asymptomatic for 12 months. No treatment-related complications and side effects occurred. Conclusions Ultrasound or CT-guided radioactive 125I seed implantation for rectal cancer is safe and minimally invasive. The incidence of complications is low and the curative effect is certain. The combination of external beam radiotherapy and systemic chemotherapy after particle therapy is expected to further improve the curative effect.