模板联合肋骨钻孔技术辅助放射性粒子植入治疗肺癌的可行性

发布时间：2018-08-25 19:48

【摘要】：目的评价模板联合肋骨钻孔技术辅助CT引导下放射性粒子植入在肺癌中应用的可行性。方法选择2015年1月至2016年6月在天津医科大学第二医院接受放射性粒子植入治疗的肺癌患者21例。植入前行胸部CT扫描获得医学数据成像信息(DICOM),导入近距离治疗计划系统(BTPS)进行预计划,处方剂量120 Gy。除常规针道设计外,对于因肋骨遮挡产生剂量冷区的靶区层面模拟经肋骨预置针道,术中采用肋骨钻孔技术建立真实进针通道,同时应用模板控制针的插植和粒子的植入,CT扫描验证插植针及粒子空间位置分布,术后即刻进行剂量验证。验证结果与术前计划的剂量参数进行配对t检验。粒子植入过程中和植入后观察并记录并发症。结果 21例肺癌患者应用模板联合肋骨钻孔技术,均顺利完成放射性粒子植入。术后剂量验证靶区的体积、粒子数、针数、D90、V100及V200的平均值分别为47.6 cc、33颗、10支、12 765.1 Gy、92.6%、34.8%,术前计划分别为46.4 cc、33颗、10支、12 433.8 Gy、95.2%、28.8%(P=0.012、0.930、0.267、0.179、0.032、0.003)。术后质量验证满意率为90.5%(19/21)。气胸发生率19%(4/21),肺内出血9.5%(2/21),胸膜腔内积血4.7%(1/21),痰中带血19%(4/21),无大咯血。粒子移位发生率9.5%(2/21)。未观察到其他严重并发症。结论应用模板联合肋骨钻孔技术辅助CT引导下肺癌放射性粒子植入,方法安全可行,插植针定位、定向精准,可较好地在术中实现术前BTPS计划目标,避免徒手操作的盲目性和剂量不精准问题,对肺癌放射性粒子治疗的规范化和质量控制具有重要价值。
[Abstract]:Objective to evaluate the feasibility of CT guided radioactive particle implantation with template and rib drilling technique in lung cancer. Methods from January 2015 to June 2016, 21 patients with lung cancer received radioactive seed implantation in the second Hospital of Tianjin Medical University. Before implantation, chest CT scan was performed to obtain medical data and imaging information. (DICOM), was imported into the brachytherapy planning system (BTPS) for pre-planning. The prescription dose was 120 Gy.. In addition to the conventional pin design, for the target plane of the cold area caused by rib occlusion, the rib drilling technique was used to establish the true needle entry channel during the operation. At the same time, the space distribution of implant needle and particle was verified by template control needle implantation and particle implantation CT scan, and the dose was verified immediately after operation. The results were matched t-test with preoperative planned dose parameters. Complications were observed and recorded during and after seed implantation. Results 21 patients with lung cancer were successfully implanted with radioactive particles by using template and rib drilling technique. The mean values of the volume, particle number and needle count of the target area were 47.6 cc,33, V100 and V200, respectively, and the preoperative plan was 46.4 cc,33, 10 branches, 10 branches, 12 433.8 Gy,95.2%,28.8%, respectively, for 12 765.1 Gy,92.6%,34.8%, (P 0. 012 0. 930 0. 267U 0. 179U 0. 1730.003). The satisfactory rate of postoperative quality verification was 90.5% (19 / 21). The incidence of pneumothorax was 19% (4 / 21), pulmonary hemorrhage 9.5% (2 / 21), intrapleural hemorrhage 4.7% (1 / 21), blood in sputum 19% (4 / 21), and no massive hemoptysis. The incidence of particle shift was 9.5% (2 / 21). No other serious complications were observed. Conclusion it is safe and feasible to use template combined with rib drilling technique to assist CT guided radionuclide implantation of lung cancer. The method is safe and feasible, the placement of implant needle is accurate, and the goal of preoperative BTPS planning can be achieved well during operation. Avoiding blindness and inaccurate dose is of great value to the standardization and quality control of radionuclide therapy for lung cancer.
【作者单位】：天津医科大学第二医院肿瘤科;天津医科大学第二医院胸外科;
【基金】：国家自然科学基金(8157102300)
【分类号】：R734.2

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