放射性125I粒子对家兔正常门静脉早期放射性损伤的实验探究.pdfVIP

f：Ⅳ： 目 录 中文摘要····················································1 英文摘要····················································4 英文缩写····················································8 研究论文放射性125I粒子对家兔正常门静脉早期放射性损伤的实验研 究 ····················································M 前言．．．．．．．．··一··一··············一·····．．．．一一··一···9 月IJ舌 材料与方法·············································10 结果·············································-·····18 附I羽···················································20 附表···················································25 _i寸{《≥···················································28 d、结···················································31 参考文献···············································32 综述一放射性粒子植入治疗消化系统肿瘤常见并发症···········35 综述二 影响放射性粒子植入临床疗效的因素···················4l 致谢·······················································47 个人简历···················································48 中文摘要 放射性125I粒子对家兔正常门静脉早期放射性损伤的实验研究 摘 要 转移是恶性肿瘤最大特点之一，淋巴结转移是主要转移途径，是决定 治疗方案及判断患者预后的重要因素。肝十二指肠韧带淋巴结是消化系统 特别是胰腺癌、肝内外胆管癌、胃癌等恶性肿瘤的常见转移部位，且转移 后由于患者期别较晚、耐受性差、周围正常组织限制等原因，手术、化疗 及外放疗等常规治疗手段难以实施，因此此部位淋巴结转移癌的治疗是临 床医师颇感棘手的问题。而放射性125I粒子的出现，因其局部剂量高，剂 量衰减快，对周围正常组织损伤小等特点，成为一种有效的治疗手段。 放射性125I粒子组织间植入是指将放射源植入肿瘤内或受肿瘤侵犯 的组织中，通过其持续发出低能量Y射线，具有对靶区肿瘤产生高剂量杀 伤作用，对周围正常组织损伤小，易防护等优势，使肿瘤组织受到最大程 度毁灭性杀伤，而正常组织不受损伤或损伤轻微。放射性125I粒子组织间 植入多用于泌尿生殖系统、头颈部、肺等实质性脏器的肿瘤【l五】，美国和 英国的最新研究表明，放射性粒子植入治疗已经成为继手术治疗之后首选 的治疗局限性前列腺癌的方法【3】。并且在妇科肿瘤【41、体表软组织恶性肉 瘤【5叫的临床应用中显示出很好的治疗效果，在空腔脏器如胃肠道【7】、食 管【8】等部位肿瘤治疗中亦进行了初步探讨，显示了喜人的疗效，大大提高 了患者生存质量，延长了患者的生存时间。近距离放射治疗以其准确定位、 高度适形性、低污染等优势得到大家的追捧，成为一种有效的治疗手段， 但在疗效得到肯定的同时我们也不能忽视放射性并发症的发生。就125I 粒子应用最广泛的前列腺癌而言，严重的并发症包括直肠溃疡、瘘、尿道 坏死和性功能障碍等，Wallner等【9】报道直肠溃疡的发生率为lO％，Blasko 发生急性尿潴留，5．6％出现便秘或里急后重感及自限性直肠出血，另外 的广泛应用，安全性问题越来越受到人们的关注。肝十二指肠韧带淋巴结 周围组织结构复杂，临近肝脏、胆管、门静脉等重要组