目的：探讨125I放射性粒子植入治疗肺门旁非小细胞肺癌中，CT四维电磁导航引导技术的临床应用价值。方法：回顾性分析26例行CT引导下肺门旁非小细胞肺癌125I放射性粒子植入治疗的患者的资料，其中16例为CT四维电磁导航引导的125I放射性粒子植入，10例为常规CT引导的125I放射性粒子植入。所有患者均进行术前计划、术中优化及术后剂量学验证。采用配对t检验比较手术前后90%靶体积的最小吸收剂量（D90）、最小周边剂量（MPD）及100%、150%、200%处方剂量覆盖的靶区体积占靶区总体积的百分比（分别为V100、V150、V200）。并比较两组手术操作时间、穿刺针调整次数、穿刺过程中总辐射剂量及并发症的情况。结果：26例患者均成功完成治疗，未发生与手术相关的严重并发症。其中，CT四维电磁导航引导组平均植入粒子33颗，常规CT引导组平均植入粒子40颗。CT四维电磁导航引导组和常规CT引导组V100术前计划分别为（95.45±1.52）%、（93.47±2.37）%，术后分别为（89.83±2.78）%、（87.85±4.35）%，术后均较术前计划减小，差异有统计学意义（P＜0.05）。两组D90、MPD、V150、V200手术前后比较差异均无统计学意义（P＞0.05）。CT四维电磁导航引导组手术操作时间为（53.3±11.4） min，穿刺针调整次数为（0.5±0.13）次，穿刺过程中总辐射剂量长度乘积（DLP）为（206.4±11.19） mGycm，较常规CT引导组手术操作时间（（66.0±12.7） min）、穿刺针调整次数（（2.08±0.11）次）、穿刺过程中总DLP（（299.9±8.402） mGycm）均减少。两组手术操作数据差异均有统计学意义（P＜0.01）。结论：应用CT四维电磁导航引导125I放射性粒子植入治疗肺门旁非小细胞肺癌，粒子植入能精确达到术前规划，可有效减少穿刺针调整次数，缩短手术时间，减少辐射剂量，提高了患者的耐受度。
Abstract
Objective: To evaluate the clinical application values of CT electromagnetic navigation system-guided 125I seed implantation therapy for parahilar non-small cell lung carcinoma(NSCLC). Methods: A total of 26 patients with parahilar NSCLC treated by CT-guided 125I seed implantation therapy were retrospectively analyzed. The 125I seed implantation procedures were performed under CT electromagnetic navigation and routine CT guidance in 16 and 10 cases, respectively. The preoperative planning designs, intraoperative optimization and postoperative dosimetry verifications were performed for all patients. The dose related parameters including D90, MPD, V100, V150 and V200 were compared between pre- and post-operation by t test. The operating time, adjustment times of puncture needle, total radiation dose during the puncture and complications were also compared between the two groups. Results: All 26 patients were treated successfully without serious procedure-related complications. An average of 33 seeds were implanted in the CT electromagnetic navigation system-guided group, and 40 seeds were implanted in the routine CT guided group. Preoperative V100 in CT electromagnetic navigation system-guided group and routine CT guided group were (95.45±1.52)% and (93.47±2.37)%, respectively. Postoperative V100 in both groups were (89.83±2.78)% and (87.85±4.35)%, respectively. There was no significant difference between pre- and post-operation for all parametersexcept for V100. The operating time was (53.3±11.4) min in CT electromagnetic navigation system-guided group and (66.0±12.7) min in routine CT guided group. The adjustment times of puncture needle were (0.5±0.13) and (2.08±0.11) in both group, respectively. Total radiation dose during the puncture was (206.4±11.19) mGycm and (299.9±8.402) mGycm in both group, respectively. Compared with routine CT guided group, the mean value of the operating time, adjustment times of puncture needle and total radiation dose during the puncture decreased in CT electromagnetic navigation system-guided group. The differences between two groups were statistically significant(P＜0.01). Conclusions: Compared with the routine CT guidance, CT electromagnetic navigation system-guided 125I seed implantation therapy for NSCLC can achieve preoperative plans accurately, and effectively reduce the adjustment times of puncture needle, shorten the operation time, reduce radiation dose and improve the patients’ tolerance.
关键词
癌 /
非小细胞肺 /
碘 /
放射学 /
介入性
Key words
Carcinoma, non-small-cell lung /
Iodine /
Radiology, interventional
中图分类号：
Ｒ734.2
Ｒ814.42
Ｒ815
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基金
上海市卫计委项目（201640125）；上海自然科学基金项目（19ZR1432600）。
