放射性粒子植入治疗晚期胰腺癌的疗效及预后分析
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摘要
目的:探讨支持治疗、姑息手术和姑息手术联合125 I粒子植入治疗无法切除晚期胰腺癌的临床疗效和预后因素。方法:选择2004年3月～2008年10月,我院不能手术切除的胰腺癌患者98例,其中支持治疗53例;姑息手术(胆肠吻合术和(或)胃空肠吻合术)24例及姑息手术联合术中放射性粒子植入治疗胰腺肿瘤21例(均行剖腹探查术,术中行胆肠吻合术和(或)胃空肠吻合术)。将年龄、性别、族别、一般状况、肿瘤分期、肿瘤部位、治疗方式等因素进行单因素分析,将单因素分析有显著性意义的变量引入Cox比例风险模型进行多因素分析。治疗后疼痛缓解程度比较应用等级资料秩和检验;放疗前后CA19-9水平的比较用配对资料t检验和秩和检验。结果:支持治疗组治疗前后疼痛部分缓解率及完全缓解率分别为61.70%(29/47)及0;姑息手术组中治疗前后疼痛部分缓解率及完全缓解率分别为60%(12/20)及0;姑息手术联合粒子植入治疗前后疼痛部分缓解率及完全缓解率分别为84.21%(16/19)及15.79%(3/19)。姑息手术联合~(125)I粒子植入治疗组疼痛部分缓解率及完全缓解率高于其它两组(P<0.017),差异有统计学意义。姑息手术联合粒子植入治疗组的中位生存期(8.6月)长于姑息手术组(5.7月)及支持治疗组(4.5月)(P<0.05),差异有统计学意义。支持治疗组和姑息手术组中CA19-9水平在治疗前后变化无统计学意义,姑息手术联合125 I粒子植入治疗组中治疗后CA19-9水平332.57±200.74u/ml,较治疗前466.15±329.51u/ml降低,差异有统计学意义。结论:对不可切除的晚期胰腺癌行125 I粒子植入治疗可以延长患者生存期,提高生活质量,且对胰腺癌引起的疼痛有较明显的缓解效果。
Objective: To study curative effects and prognosis of advanced pancreatic carcinoma with ~(125)I seeds implantation. Methods: 98 patients with unresectable and advanced pancreatic carcinoma admitted from Mar.2004 to Oct.2008 were analyzed with Cox proportional hazard model. 53 cases were treated by the supportive care; 24 cases by palliative operation and 21cases by palliative operation combined with iodine-125 seed implantation。Wilcoxon test for pain relieving rate Preoperative and postoperative with three group; pairing data t test and Wilcoxon test for CA19-9 levels Preoperative and postoperative with three group. Results:The major factors affecting prognosis was treatment. Palliative operation combined with ~(125)I seeds implantation radiotherapy could relieve pain than other treatments. Among the 21 patients who suffered pain before radiotherapy, complete response was obtained in84.21% (16/19), partial response in15.79% (3/19) which is significantly higher than that of other two groups and there is a difference (P<0.017). The median survival time in palliative operation combined with iodine-125 seed implantation was 8.6month, which was significantly longer than other two groups (4.5month, 5.7month) and there is a difference. (P<0.05). CA19-9 levels Preoperative and postoperative manifest decrease in palliative operation combined with iodine-125 seed implantation than other two groups and there is a difference. (P<0.017). Conclusion: Palliative operation combined with ~(125)I seeds implantation would improve the prognosis of advanced pancreatic carcinoma. It does show some therapeutic effects for advanced pancreatic carcinoma, in terms of pain relieving rate, CA19-9 levels and median survival time.
Objective: To study curative effects and prognosis of advanced pancreatic carcinoma with ~(125)I seeds implantation. Methods: 98 patients with unresectable and advanced pancreatic carcinoma admitted from Mar.2004 to Oct.2008 were analyzed with Cox proportional hazard model. 53 cases were treated by the supportive care; 24 cases by palliative operation and 21cases by palliative operation combined with iodine-125 seed implantation。Wilcoxon test for pain relieving rate Preoperative and postoperative with three group; pairing data t test and Wilcoxon test for CA19-9 levels Preoperative and postoperative with three group. Results:The major factors affecting prognosis was treatment. Palliative operation combined with ~(125)I seeds implantation radiotherapy could relieve pain than other treatments. Among the 21 patients who suffered pain before radiotherapy, complete response was obtained in84.21% (16/19), partial response in15.79% (3/19) which is significantly higher than that of other two groups and there is a difference (P<0.017). The median survival time in palliative operation combined with iodine-125 seed implantation was 8.6month, which was significantly longer than other two groups (4.5month, 5.7month) and there is a difference. (P<0.05). CA19-9 levels Preoperative and postoperative manifest decrease in palliative operation combined with iodine-125 seed implantation than other two groups and there is a difference. (P<0.017). Conclusion: Palliative operation combined with ~(125)I seeds implantation would improve the prognosis of advanced pancreatic carcinoma. It does show some therapeutic effects for advanced pancreatic carcinoma, in terms of pain relieving rate, CA19-9 levels and median survival time.
引文
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[21]刘军楼,许国铭.胰腺癌近距离放疗研究进展[J].中华胰腺病杂志. 2008, 8(2):138-139.
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