Intra-operative Implantation With I¹²⁵ Seeds In The Treatment Of Advanced Pancreatic Cancer: The Assistant Design Of3D Model And The Research Of Implantation Way

In this study, we through the establishment of unresectable advancedpancreatic cancer patients with preoperative three-dimensionaldigital model, research to develop radioactive seeds implantation ofI125planning and implantation method. At the same time through doublebypass operation (biliary obstruction, gastrointestinal anastomosis)to solve patients’ present symptoms, such as pain, jaundice, gastricemptying and so on. Pancreatic cancer is very poor, surgical operationis the only cure method for the treatment of pancreatic cancer, butonly5%to22%of patients can accepted radical resection operation,the other patients can only accept expectant treatment. RadioactiveI125seeds implantation is an effective method in the treatment of theimproved pancreatic cancer. We found that radioactive seedsimplantation through a comprehensive literature analysis andpre-experiment can improve the survival time of the patients. That isto say the maximum implantation according to the three-dimensionalshape of the tumor, in this case, we can prolong the survival time ofpatients. And through pre-experiment we found that some patients canobtain the same survival time with radical resection operation. So thisarticle’ targets are to improve the survival time of patients andimprove the quality of life of patients.Objective: The purpose of this paper is divided into two parts, thefirst part starts from the3D model design and implantation method.The design of3D software system for the preoperative3D model ofparticle implantation, is expected to fully cover the tumor and noblind spot, while not harming the surrounding tissues and the bloodvessels. The second part according to the seeds implantation method.According to the quality of life, survival period of patients, thefeasibility analysis of safety to evaluate its clinical value.Methods: According to the inclusion criteria, using FitMe3Dreconstruction software system,47patients with advanced pancreaticcancer in PLA General Hospital from2009January to2013December inour hospital department of hepatobiliary surgery. We finished3Dreconstruction of pancreatic tumor and surrounding blood vessels, tissue, and according to the calculation of three-dimensional spaceposition of the tumor, calculate the number of seeds neededimplantation, and simulation of seed implantation. Operation in strictaccordance with the preoperative design, particle on the possibleexistence of blind spot. Analysis and research of imaging data,treatment, follow-up results etc. And in our hospital underwentpalliative operation treatment of78patients with advanced pancreaticcancer as the control group, the clinical data between the two groupsof patients were compared and analyzed.Result.1. During the study period, a total of47cases of advanced pancreaticcancer patients with seeds implantation, including29cases of male,female18cases. Ages were36-87years old, and the average age was57.6±12years old.2. The design of FITME3D reconstruction software system forpreoperative3D model of seed implantation,3D reconstruction ofpancreatic tumor and surrounding blood vessels, tissue, calculatetumor stereo space position, calculate the number of seeds neededimplantation, and simulate the process of particle implantation.3. All patients underwent intraoperative I125implantation,implantation for16-116seeds, with an average of53.1±19.8seeds,5of them underwent gastrointestinal anastomosis,10cases underwentbiliary-enteric anastomosis,13cases underwent biliary-entericanastomosis and gastrointestinal anastomosis,19patients onlyreceived seeds implantation.4. Seed group of patients with postoperative gastroparesis in11cases,1case of biliary fistula,1case of bacteremia,9patients hadpancreatic fistula,8cases of Grade A,1case of Grade B,1patientoccurred intraperitoneal hemorrhage at twelfth days after operationand cured by conservative therapy. Complications contains10cases ofClavien grade I, II grade of13cases, no peri-operation period deathpatients. Postoperative complications of seed group occurredsignificantly higher than the total number of patients in the controlgroup, and the postoperative hospitalization time was longer thancontrol group patients. But seed implantation did not increase severecomplications (Clavien grade>II) incidence, no peri-operation perioddeath patients. Seed implantation in patients of pancreatic fistulaand gastroparesis incidence was higher than that of the control groupof patients. The first symptom of25cases with abdominal pain topatients, postoperative abdominal pain patients was8cases, divided into5mild cases,3severe cases, the remission rate of abdominal painwas88%(22/25). The data of11patients with postoperativegastroparesis, through statistical analysis and consideration, theoccurrence of postoperative gastroparesis is closely related towhether gastrointestinal anastomosis, and at the same time for seedimplantation.5. S eed group of47patients,42cases were followed up, thefollow-up rate was89.4%. The one month, half of year, one year, andtwo year survival rates of particle group were97.6%,62.4%,25.8%and14.3%, the average survival time was13.0±1.2months. The survivalrates and time were significantly higher than control group(P<0.05).Conclusion:1. For can’t radical resection patients with advanced pancreaticcancer, radioactive seeds implantation is a safe and effectivetreatment method.2. Radioactive seeds implantation did not increase the risk of deathin patients, is safe and feasible, which can obviously prolong thesurvival time of patients with advanced pancreatic cancer, improve thequality of life of patients.3. By using the method of preoperative three-dimensional simulationof particle implantation, namely the maximum according to thethree-dimensional shape of tumor implantation, could prolong thesurvival time of patients, and even some patients can obtain treatmentas the radical operation.