中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2020, Vol. 18 ›› Issue (3): 272-277.doi: 10.19438/j.cjoms.2020.03.017

• 临床总结 • 上一篇    下一篇

数字化导航引导下125I精确植入治疗9例颅底腺源性恶性肿瘤的效果评价

葛胜优1,2, 周凯1,2, 孔钰1,2, 高策1,2, 宋凯1,2, 冯元勇1,2, 尚伟1,2,*   

  1. 1.青岛大学附属医院 口腔颌面外科,山东 青岛 266000;
    2.青岛大学 口腔医学院,山东 青岛 266000
  • 收稿日期:2019-11-08 修回日期:2020-01-06 发布日期:2020-06-18
  • 通讯作者: 尚伟,E-mail：liweishang@126.com
  • 作者简介:葛胜优（1993-）,男, 在读硕士研究生,E-mail:shengyouge@163.com

Accurate implantation of 125I seeds guided by digital navigation for the treatment of 9 patients with adenogenous malignant tumors of the skull base

GE Sheng-you1,2, ZHOU Kai1,2, KONG Yu1,2, GAO Ce1,2, SONG Kai1,2, FENG Yuan-yong1,2, SHANG Wei1,2   

  1. 1. Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Qingdao University. Qingdao 266000;
    2. School of Stomatology, Qingdao University. Qingdao 266000, Shandong Province, China
  • Received:2019-11-08 Revised:2020-01-06 Published:2020-06-18

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摘要： 目的 探讨数字化导航引导下125I粒子精确植入治疗颅底腺源性恶性肿瘤的可行性及疗效。方法 选取2017年9月—2019年9月应用数字化导航引导,行125I粒子近距离植入治疗颅底恶性肿瘤的患者9例。植入术前应用三维治疗计划系统制定粒子植入计划。将三维CT数据导入导航软件AccuNavi-A 2.0 中,进行三维重建,确定粒子植入方向、角度及深度。术中按术前计划植入穿刺针,在导航引导下,调整定位针位置及方向,穿刺进入颅底靶区及周围组织,植入125I粒子。实时验证125I粒子植入位置。术后定期随访,比较术前、术后CT中肿瘤及靶区2个垂直的最大直径的乘积,统计局部复发率、局部控制率等指标。结果 9例颅底恶性肿瘤患者,腺样囊性癌5例,黏液表皮样癌2例,肌上皮癌1例,腺泡细胞癌1例。随访时间3~36个月,中位随访时间17个月,无失访病例。局部复发率11.1%,局部控制率77.78%。导航精确度达0.2~1.5 mm,未出现3级及以上放射性损伤。其中手术切缘阳性,未完整切除的5例患者中, CR 3例,PR 2例。2例切缘阴性患者,复查至今未发现明显新生物。外院手术后复发的2例患者,于数字化导航引导下行125I粒子植入治疗,术后CR 1例,PR 1例。结论 颅底恶性肿瘤位置隐蔽,毗邻重要解剖结构,空间狭小,手术视野受限,单纯手术难以根治。导航引导下125I粒子植入治疗颅底恶性肿瘤具有靶区定位精准、局部控制率高、正常组织损伤小、作用持续、安全、微创的特点,为辅助治疗颅底恶性肿瘤提供了可靠保障,值得临床推广。

关键词: 数字化导航, 125I粒子, 颅底恶性肿瘤, 近距离放射治疗

Abstract: PURPOSE: To investigate the feasibility and efficacy of accurate implantation of 125I seeds guided by digital navigation for the treatment of adenogenous malignant tumors of the skull base. METHODS: A series of 9 patients received digital navigation guided interstitial 125I seeds implantation. CT scanning was performed precisely and the plan of 125I implantation was designed systematically with the aid of Treatment Planning System(TPS) and AccuNavi-A navigation system. 125I was delivered into the target region according to the position and direction defined by the designed implantation plan and digital navigation during the process of implantation. Real-time assessment was required to find if the position of 125I corresponded with preoperative plan. All patients underwent regular reexamination to compare the tumor size preoperatively and postoperatively. The recurrent rate and local control rate were evaluated and the adverse events observed. RESULTS: 125I seeds were implanted successfully in target-area of all 9 patients. The recurrence rate was 11.1% and the local control rate (CR+PR) was 77.8% without severe side effects during follow-up at 3-36 months in all patients. CONCLUSIONS: Traditional resection carried a high risk of postoperative complications because the base of the skull is concealed, with a narrow space and limited field of vision. Accurate implantation of 125I with the use of digital navigation imaging guidance is an effective,minimally invasive and safe method for treating adenogenous malignant tumors of the skull base and should be considered for conditional use.

Key words: Digital navigation, 125I seeds, Adenogenous malignant tumors of skull base, Interstitial brachytherapy

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