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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。
Objective To evaluate the feasibility of using template-assisted rib drilling to assist CT-guided implantation of radioactive particles in lung cancer. Methods Twenty-one patients with lung cancer undergoing radioactive particle implantation at the Second Hospital of Tianjin Medical University from January 2015 to June 2016 were selected. Medical imaging data (DICOM) were obtained by chest CT scan before implantation and were introduced into the brachytherapy system (BTPS) for preplanning. The prescribed dose was 120 Gy. In addition to the conventional design of the needle track, for the target area level due to rib occlusion to produce dose-cooling zone, a preset needle path through the rib is simulated. During the operation, a real bore approach is established by using rib drilling technique. At the same time, Implantation and CT scanning were performed to verify the placement of the needle and the spatial distribution of the particles. The dose was immediately verified immediately after the procedure. The validation results were paired t-test with the preoperative planned dose parameters. During and after implantation, the complications were observed and recorded. Results 21 cases of lung cancer patients using template combined with rib drilling technology, have successfully completed the radioactive particle implantation. The volume, number of particles, number of stitches, D90, V100 and V200 in the target area of postoperative dose verification were 47.6 cc, 33, 10, 12.765.1 Gy, 92.6% and 34.8% respectively. The preoperative plans were 46.4 cc, 33, 10, 12 433.8 Gy, 95.2%, 28.8% (P = 0.012, 0.930, 0.267, 0.179, 0.032, 0.003). The satisfactory rate of postoperative quality verification was 90.5% (19/21). Pneumothorax 19% (4/21), intrapulmonary hemorrhage 9.5% (2/21), intrapleural hemorrhage 4.7% (1/21), sputum with blood 19% (4/21), no major hemoptysis. The incidence of particle displacement 9.5% (2/21). No other serious complications were observed. Conclusions Template-assisted rib drilling technique is used to assist the CT-guided implantation of radioactive particles in lung cancer. The method is safe and feasible. The positioning of the inserted needle and the orientation are accurate. The goals of preoperative BTPS planning can be achieved well during surgery to avoid blindness And inaccurate dosimetry issues, is of great value to the standardization and quality control of radioactive particle therapy for lung cancer.