Ultrasound-guided Percutaneous Trans-gastricwall Puncture Interstitial Implantation Of ¹²⁵I Seeds In Advanced Pancreatic Cancer

Objective:To investigate the clinical efficacy of ultrasound-guided percutaneous trans-gastricwall puncture interstitial implantation of ¹²⁵I seeds in advanced pancreatic cancer,and ultrasound-guided percutaneous trans-gastricwall puncture of safety,feasibility and the operative skills.Method:Collecting 55 patients with unresectable advanced pancreatic cancer in our hospital of May,2006 to January,2016.There were 29 male patients and 26 female patients,the ages ranged from 28 to 80 years old,the average age was 63.67±9.87 years old.The maximal of long diameter of tumor was range from 1 to 6.9 centimeter,the average long diameter was 3.89±1.40 centimeter.There was 40 cases pancreatic head tumer,and 15 cases pancreatic body and tail tumer.The main clinical symptoms of 42patients were abdominal and/or back pain of different degrees.The serum tumor marker CA19-9 rised in 41 patients in different degrees.All patients were treated by ultrasound-guided percutaneous trans-gastricwall puncture interstitial implantation of¹²⁵I seeds.The pain degree changes were observed after the operation,and evaluation the pain relief.Following up 2 to 24 months,regular reexamination abdominal ultrasound examination and CT examination and serum CA19-9 et al,recording the local control of the tumor,the changes of serum CA19-9,the occurrence of complications and the survival time of the patients.Results:（1）Pain relief:There were 55 patients of advanced pancreatic cancer,42 patients had different degrees of pain symptoms before operation,and pain symptoms began to remission from 2 to 5 days,complete relief patients were 28 cases,partial relief patients were 10 cases,invalid patients were 4 cases,and pain relief rate was 90.5%.（2）Local control of the tumor:Comparisons between preoperative and CT images 3months after the operation,The results were CR 14 cases,PR 30 cases,SD 7 cases,PD 3cases.The rate of local control was 81.5%.（3）Changes of serum CA19-9:There were41 patients had different levels of serum CA19-9 rised before operation,1 months after the operation,6 cases declined to the normal range（<37U/ml）,33 cases were decline in different degrees,2 cases were rised.（4）Complications:10 cases with gastrointestinal decompression pipe a little of blood after operation 1 to 2 days,5 cases with fever symptoms（≤39.5℃）after operation 2 to 5 days,1 case with incomplete intestinal obstruction after operation 1 month,all of them were relief after given symptomatic treatment.None of the patients had complications such as gastric perforation,pancreatic fistula,bile fistula,particle displacement et al.（5）Survival time:Following up 2 to 24 months,1 case died of acute myocardial infarction at 2 months after operation,the patients’survival rate of 6 months was 85.5%,the survival rate of 1 year was 38.2%,and the survival rate of 2 years was 18.2%.The median survival time was10 months.Conclusion:1.Ultrasound-guided percutaneous trans-gastricwall puncture interstitial implantation of ¹²⁵I seeds in advanced pancreatic cancer has obvious clinical effect in relieving pain,controlling tumor progression and improving the quality of life et al.2.Ultrasound-guided percutaneous trans-gastricwall puncture is minimal invasive,safe,feasible and less complications.It is worthy of clinical application.