目的 探讨符合线路SPECT/CT辅助引导靶区定位技术,在经皮穿刺种植125I粒子治疗中心型肺癌并发阻塞性肺不张中的价值.方法 选择35例术前CT检查可疑为中心型肺癌导致阻塞性肺不张,但不能分辨肿瘤和肺不张边界的患者,行符合线路SPECT/CT检查,根据采集到的图像勾画肿瘤靶区,将CT图像和SPECT/CT图像输入治疗计划系统(TPS)对病灶进行三维重建,计算粒子数和放射剂量,在TPS下模拟布源,并在CT引导下经皮穿刺植入125I粒子,治疗后6个月,根据CT检查比较肿瘤体积,按国际标准判定疗效.结果 所有病例经SPECT/CT检查均可清晰显示肿块与肺不张的界限,肿瘤靶区体积平均约为64 cm3,而CT检查的靶区体积平均约为112 cm3,治疗6个月后,完全缓解率+部分缓解率为91.4％,未发生与治疗相关的严重并发症.结论 符合线路SPECT/CT检查对于确定中心型肺癌并发阻塞性肺不张肿瘤靶区勾画的价值明显优于CT检查,有利于放射性粒子植入治疗.%Objective To evaluate percutaneous puncturing 125I seeds implantation by using SPECT/CT guided target localization technique in treating central lung cancer complicated by obstructive pulmonary atelectasis. Methods A total of 35 patients with suspected central lung cancer complicated by obstructive pulmonary atelectasis on preoperative CT were enroll in this study- As no clear distinction existed between the tumor and the atelectatic consolidation shadow on CT scanning, an additional SPECT/CT scanning was adopted. After ascertaining the location of the lung cancer, percutaneous puncturing implantation of 125I seeds under SPECT/CT guidance was performed. The clinical data and the therapeutic results were evaluated. The carcinoma was scanned by CT and compared with 6 months after treatment. All the patients were followed-up for 6 to 18 months. Results A sharp distinction between the tumor and the atelectatic consolidation shadow was demonstrated on SPECT/CT scans in 35 cases. The mean volume of the targeted lesion reckoned from SPECT/CT and CT scans were 64 cm3 and 112 cm3, respectively, and the 125I seeds were implanted. Among the 35 followed-up cases, the complete and partial remission rate was 91.4% (32/35) , and no major complications. Conclusion SPECT/CT scans is more accurate than CT alone in the determining the radiation target volume in patients with central lung cancer complicated by obstructive pulmonary atelectasis.
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