| Objective:The pancreas is an elongated organ located behind the peritoneum,adjacent to blood vessels,bile ducts,pancreatic ducts and duodenum,and is largely obscured in front of it by the gastrointestinal tract.Pancreatic cancer includes cancers of the head of the pancreas and the tail of the pancreas,with the head of the pancreas accounting for a higher proportion of cancers than the tail of the pancreas.In the process of radioactive 125 I seeds implantation in patients with pancreatic cancer,most of the puncture routes are percutaneous through the gastrointestinal tract,which inevitably results in the occurrence of medically induced gastrointestinal perforation.Therefore,strict symptomatic treatment such as water fasting,acid and enzyme suppression is required after radioactive 125 I seeds implantation.In contrast,a small number of pancreatic cancer patients avoiding perforation through the gastrointestinal tract are also able to accomplish reasonable seeds space and dose distribution.This study will discuss the comparative analysis of ultrasound-guided radioactive 125 I seeds implantation via gastrointestinal puncture versus implantation without gastrointestinal puncture for the treatment of pancreatic cancer.Method:Using a retrospective analysis,clinical data were collected from 66 patients attending a hospital of Jilin University Sino-Japanese Friendship who underwent ultrasound-guided radioactive 125 I seeds implantation for pancreatic cancer.Among them,39 patients underwent gastrointestinal puncture during the puncture procedure,and 27 patients avoided the gastrointestinal tract in the choice of puncture access for puncture.The patients in the transgastrointestinal tract group and the nongastrointestinal tract group were comprehensively analysed in terms of time to stop gastrointestinal decompression after surgery,duration of postoperative water fasting,number of postoperative hospital days,total hospital days,total hospital costs,postoperative complications,postoperative pain relief compared with preoperative pain and local control of tumour.SPSS statistical software was used for data analysis,and the differences were considered statistically significant at P < 0.05 when comparing between the two groups.Result:All 66 patients in this study were successfully implanted with radioactive 125 I seeds according to the preoperative designed puncture route,and the spatial disposition of the seeds was verified to be satisfactory intraoperatively and postoperatively.In 39 patients in the group with puncture access through the gastrointestinal tract compared with 27 patients in the group without puncture access through the gastrointestinal tract:median time to stop gastrointestinal decompression postoperatively(3 days versus 2days,P<0.001).Postoperative fasting time in water(3 days vs.2 days,P<0.001).Mean postoperative hospital stay(5.25±1.32 days versus 4.06±1.53 days,P<0.001).Mean total hospital stay was(13.90±1.89 days vs.11.96±3.29 days,respectively,P<0.001).The mean total hospital cost was(3.12±0.16 million versus 283±0.16 million,P<0.001).Postoperative complications: In the 39 patients in the group with puncture access through the gastrointestinal tract,8 patients developed microbleeding in the gastrointestinal decompression tube within 1-2 days after surgery,5 patients developed limited peritonitis within 1-3 days after surgery,and 7 patients developed fever within1-5 days after surgery.27 patients in the group with puncture access not through the gastrointestinal tract,no patient developed microbleeding in the gastrointestinal decompression tube within 1-2 days after surgery,and 1 patient had limited peritonitis within 1 to 3 days postoperatively,and 2 patients had fever within 1 to 5 days postoperatively.No complications requiring surgical treatment such as biliary fistula,pancreatic fistula,perforation of the digestive tract or displacement of seeds were observed in either group.Changes in pain: In the group with the puncture route through the gastrointestinal tract,38 patients had varying degrees of pain in the upper abdomen and/or low back before surgery.The pain relief rate was 89.5%;in the nongastrointestinal group,18 patients had varying degrees of upper abdominal and/or low back pain before surgery,with 13 cases of complete pain relief,2 cases of partial pain relief and 3 cases of no pain relief after surgery.The pain relief rate was 83.3%.Change in tumour size at 3 months after surgery: in the transgastric group,there were 10 CR cases,19 PR cases,7 SD cases,3 PD cases,and 29 treatment effective(CR+PR)cases,with an effective remission rate of 74.4%;in the non-gastric group,there were 9 CR cases,12 PR cases,5 SD cases,1 PD case,and 21 treatment effective(CR+PR)cases.21 cases,with an effective remission rate of 77.8%.The effective remission rate was77.8%.p=0.750 by chi-square test between the two groups of patients.Conclusion:1.Ultrasound-guided radioactive 125 I seeds implantation for pancreatic cancer is associated with earlier cessation of gastrointestinal decompression,shorter postoperative water fasting,fewer postoperative hospital days and total hospital days,less total hospital costs,and less postoperative complications than transgastric route.Therefore,when designing the preoperative puncture route,preference should be given to avoiding or reducing the number of gastrointestinal punctures for radioactive 125 I seeds implantation.2.Ultrasound-guided radioactive seeds implantation for pancreatic cancer can not only provide effective pain relief,but also significantly improve the control rate of local tumour development and effectively improve patients’ survival and quality of life,regardless of whether the puncture route passes through the gastrointestinal tract. |
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