头颈部肿瘤放疗个性化口腔定位支架的设计与制作

发布时间：2018-01-22 22:56

本文关键词： 头颈部肿瘤放射疗法个性化口腔定位支架开口压舌支架开口推舌支架　出处：《医学研究生学报》2017年03期 　论文类型：期刊论文

【摘要】：目的头颈部肿瘤患者放疗过程中使用口腔支架能有效减少正常组织的受照剂量,降低口腔黏膜炎等并发症的发病率,但目前支架的设计与制作工艺尚未有报道。文中旨在为头颈部肿瘤放疗患者设计制作个性化口腔定位支架,使部分正常组织远离放疗靶区并保持精确可重复的稳定位置,有效减低受照剂量。方法选取2016年3月至8月南京军区南京总医院放疗科接受放射治疗的头颈部肿瘤初治患者9例。根据患者肿瘤位置和放疗计划的不同,采用取模、制作蜡型、充塑抛光等活动义齿制作工艺,制作出符合患者口腔条件的个性化口腔定位支架。结果成功研究制作出2种口腔定位支架,开口压舌支架和开口推舌支架。开口压舌支架由压舌板和开口堤2部分组成,支架置入口内后,患者上下颌牙颌面与开口堤上下颌接触面切迹完全吻合,打开患者咬合,上下颌间形成空腔,舌体始终处于压舌板下,可直视患者悬雍垂和咽后壁。开口推舌支架由向后向上推舌板和开口堤2部分组成。佩戴口腔支架后患者舌体,口底,下颌骨等软硬组织离放疗高剂量区距离较未佩戴支架时远。结论研究制作的个性化口腔支架能实现精确定位并有效减少肿瘤周围部分正常组织的受照剂量,有利于临床推广。
[Abstract]:Objective to reduce the radiation dose of normal tissue and the incidence of complications such as oral mucositis in patients with head and neck neoplasms by using oral stents during radiotherapy. However, the design and fabrication of stent has not been reported. The purpose of this paper is to design and make personalized oral stents for patients with head and neck tumor radiotherapy. Keep part of normal tissue away from the target area of radiotherapy and maintain an accurate repeatable and stable position. Methods from March 2016 to August, 9 patients with head and neck neoplasms received radiotherapy in the Department of radiotherapy of Nanjing military region General Hospital, Nanjing military region. . By taking mold, making wax type, plastic filling and polishing, the individualized oral positioning stent was made. Results two kinds of oral positioning scaffolds were developed successfully. The open tongue compression stent consists of two parts: the tongue depressor plate and the opening dike. After the stent is placed into the mouth, the maxillofacial notch of the upper and lower mandible and the upper and lower face of the opening dike are completely consistent with each other. Open the bite of the patient, the upper and lower mandibular cavity formed, tongue body is always under the pressure of the tongue plate. Can see the uvula and the back pharynx wall directly. The opening and pushing tongue bracket consists of two parts: backward upward pushing tongue plate and opening embankment. After wearing the oral stent, the patient's tongue body, mouth floor. Mandibular soft and hard tissues are far away from the high dose area of radiotherapy. Conclusion the individualized oral stents can achieve accurate localization and effectively reduce the exposure dose of normal tissues around the tumor. It is beneficial to clinical popularization.
【作者单位】：南京大学医学院附属金陵医院(南京军区南京总医院)口腔科;南京大学医学院附属金陵医院(南京军区南京总医院)放疗科;
【基金】：国家自然科学基金(81571817) 全军后勤科技研究面上项目(CNJ14C005) 江苏省自然科学基金(BK20140031) 江苏省“六大人才高峰”D类资助(2014-WSN-054)
【分类号】：R739.91;R730.55
【正文快照】： 0引言放疗是目前治疗头颈部鳞状细胞癌的主要非手术方法[1-2],接受放疗的头颈部肿瘤Ⅰ期和Ⅱ期患者5年生存率80%,Ⅲ期和Ⅳ期可达60%~70%[3]。但肿瘤周围的口腔正常软硬组织受照剂量过大时,会出现一系列的放射性损伤,如:口腔黏膜炎、口干症、吞咽困难、味觉改变、放射性龋齿等

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