~(125)Ⅰ粒子植入术后肿瘤针道种植转移的临床观察
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摘要
目的探讨经皮~(125)Ⅰ粒子植入术后肿瘤针道种植转移的临床观察。方法回顾性分析2007年1月至2017年1月接受CT导引下经皮~(125)Ⅰ粒子植入治疗1 260例患者临床资料。结果 6例(0.48%,6/1 260)患者发生针道种植转移,其中肝癌4例,肺癌2例,患者平均使用穿刺针(9.5±3.8)根;平均植入粒子数(80.8±42.9)颗;发现针道种植转移的平均时间为(113.7±34.3)d;种植瘤平均体积8.09 cm3;病理结果示3例低分化,2例中低分化,1例为高分化。针对转移灶治疗方式:1例放弃治疗,3例行~(125)Ⅰ粒子植入治疗,1例行外科切除,1例行常规放射治疗,治疗的5例患者均取得良好的肿瘤局部控制效果,无患者因针道转移病灶导致死亡。结论经皮~(125)Ⅰ粒子植入治疗后可能发生肿瘤针道种植转移,但发生率低,经过积极治疗后,不会成为患者的致死因素。
Objective To discuss the clinical features of neoplasm needle track implantation metastasis after125 I seed implantation. Methods The clinical data of 1260 patients, who received CT-guided percutaneous125 I seeds implantation during the period from January 2007 to January 2010 at authors' hospital, were retrospectively analyzed. Results A total of 6 patients(0.48%,6/1260) developed neoplastic needle tract seeding, including 4 patients with liver cancer and 2 patients with lung cancer. The average number of used puncture needle was(9.5±3.8) needles, the average number of implanted125 I seed was(80.8±42.9) seeds. The mean time to discover needle track implantation metastasis was(113.7 ±34.3) d, and the mean volume of implanted tumor was 8.09 cm3. Pathological examination showed that poorly-differentiated cancer was seen in 3 patients, mid-poorly-differentiated cancer in 2 patients, and well-differentiated cancer in one patient. One patient gave up treatment, 3 patients received CT-guided percutaneous125 I seeds implantation, one patient underwent surgical resection, and one patient received routine radiotherapy.Satisfactory local control effect of tumor was obtained in all 5 patients who received treatments. No death due to neoplasm needle track implantation metastasis occurred. Conclusion Neoplasm needle track implantation metastasis may occur after percutaneous125 I seeds implantation therapy, although the incidence is extremely low. Usually, neoplasm needle track implantation metastasis will not become the lethal factor when active treatment is properly adopted.
Objective To discuss the clinical features of neoplasm needle track implantation metastasis after125 I seed implantation. Methods The clinical data of 1260 patients, who received CT-guided percutaneous125 I seeds implantation during the period from January 2007 to January 2010 at authors' hospital, were retrospectively analyzed. Results A total of 6 patients(0.48%,6/1260) developed neoplastic needle tract seeding, including 4 patients with liver cancer and 2 patients with lung cancer. The average number of used puncture needle was(9.5±3.8) needles, the average number of implanted125 I seed was(80.8±42.9) seeds. The mean time to discover needle track implantation metastasis was(113.7 ±34.3) d, and the mean volume of implanted tumor was 8.09 cm3. Pathological examination showed that poorly-differentiated cancer was seen in 3 patients, mid-poorly-differentiated cancer in 2 patients, and well-differentiated cancer in one patient. One patient gave up treatment, 3 patients received CT-guided percutaneous125 I seeds implantation, one patient underwent surgical resection, and one patient received routine radiotherapy.Satisfactory local control effect of tumor was obtained in all 5 patients who received treatments. No death due to neoplasm needle track implantation metastasis occurred. Conclusion Neoplasm needle track implantation metastasis may occur after percutaneous125 I seeds implantation therapy, although the incidence is extremely low. Usually, neoplasm needle track implantation metastasis will not become the lethal factor when active treatment is properly adopted.
引文
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[2]孔国强,高社干,任婧,等.腹腔热化疗联合静脉化疗治疗恶性腹水的临床观察[J].实用中西医结合临床,2018,18:107-108.
[3]Van Houdt WJ,Schrijver AM,Cohen-Hallaleh RB,et al.Needle tract seeding following core biopsies in retroperitoneal sarcoma[J].Eur J Surg Oncol,2017,43:1740-1745.
[4]Sumiyoshi T,Shima Y,Nishiuchi R,et al.Needle tract implantation of hepatoblastoma after percutaneous needle biopsy:report of a case[J].Surg Today,2014,44:1138-1141.
[5]王娟,公维宏,范会革,等.放射性粒子植入术针道医源性肿瘤种植转移的临床观察[J].中华放射肿瘤学杂志,2007,16:253-254.
[6]Ochsner A,Debakey M.Significance of metastasis in primary carcinomas of the lung[J].J Thorac Surg,1942,11:357-387.
[7]Ryd W,Hagmar B,Eriksson O.Local tumour cell seeding by fine-needle aspiration biopsy.A semiquantitative study[J].Acta Pathol Microbiol Immunol Scand A,1983,91:17-21.
[8]Chang S,Kim SH,Lim HK,et al.Needle tract implantation after percutaneous interventional procedures in hepatocellular carcinomas;Lessons learned from a 10-year experience[J].Korean J Radiol,2008,9:268-274.
[9]Chang S,Kim SH,Lim HK,et al.Needle tract implantation after sonographically guided percutaneous biopsy of hepatocellular carcinoma:evaluation of doubling time,frequency,and features on CT[J].AJR Am J Roentgenol,2005,185:400-405.
[10]Kosugi C,Furuse J,Ishii H,et al.Needle tract implantation of hepatocellular carcinoma and pancreatic carcinoma after ultrasound-guided percutaneous puncture:clinical and pathologic characteristics and the treatment of needle tract implantation[J].World J Surg,2004,28:29-32.
[11]王娟,隋爱霞,赵静,等.CT引导下经胃入路125I粒子治疗腹膜后转移癌10例[J].介入放射学杂志,2015,24:698-701.