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目的 探讨应用肿瘤组织间三维立体定向放射治疗计划系统 (TPS)、CT引导下经皮穿刺种植放射性12 5I粒子治疗晚期非小细胞肺癌及并发症处理方法。方法 随机选择 5 3例术前活检证实为非小细胞肺癌患者 ,应用TPS计算出放射源—12 5I粒子在瘤灶区的剂量分布 ,绘出等剂量曲线及适形粒子分布图并制定治疗计划 ,通过CT引导经皮穿刺种植12 5I粒子。术后即刻CT扫描验证 ,术后2个月复查CT检查肿瘤情况。结果 植入粒子后 ,瘤体接受的平均照射剂量为 15 0 .5Gy ,mPD84 .6Gy,D90 92 .4Gy,D90 >mPD。 2例需要立即补种粒子。术后 2个月复查的 37例患者 ,胸CT显示完全缓解 10例 ,部分缓解 2 7例。并发症包括术中气胸 19例 ,咳血 7例 ,术后发烧 5例 ,4例粒子移位 ,2例游走。结论 TPS立体定向CT引导下经皮穿刺种植放射性12 5I粒子是一种有效的、微创的治疗晚期非小细胞肺癌的方法
Objective To investigate the application of three-dimensional stereotactic radiotherapy planning system (TPS) between tumor tissues and CT-guided percutaneous implantation of radioactive 125I particles in the treatment of advanced non-small cell lung cancer and its complications. Methods Totally 53 patients with non-small cell lung cancer who were confirmed by preoperative biopsy were randomly selected. TPS was used to calculate the dose distribution of radioactive source-125I in the tumorous area. The isodose curve and conformal particle distribution map were drawn and the treatment plan was drawn Percutaneous CT guided percutaneous implantation of 125I particles. CT scan immediately after the verification, 2 months after the review of CT examination of the tumor. Results After the implantation of the particles, the average radiation dose accepted by the tumor was 15 0 .5 Gy, mPD84 .6 Gy, D90 92 .4 Gy, D90> mPD. 2 patients need to replant the particles immediately. Thirty-seven patients who underwent 2-month follow-up showed that CT was complete remission in 10 cases and partial remission in 27 cases. Complications included 19 cases of pneumothorax during operation, 7 cases of hemoptysis, 5 cases of postoperative fever, 4 cases of particle displacement and 2 cases of walking. Conclusion TPS stereotactic CT-guided percutaneous implantation of radioactive 12 5I particles is an effective and minimally invasive method for the treatment of advanced non-small cell lung cancer