头颈部肿瘤放疗个性化口腔定位支架的设计与制作  

Design and fabrication of personalized customized oral positioning stent for radiotherapy of head and neck tumor

作　　者：陈枫[1] 朱锡旭[2] 臧圣奇[1] 穆睿[1] 朱磊[1] 史小蕾[1] 张朦[2] 袁喜[2] 沈君姝[2] 金磊[1] 

机构地区：[1]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,南京医学硕士研究生210002 [2]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,南京210002

出　　处：《医学研究生学报》2017年第3期271-274,共4页Journal of Medical Postgraduates

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)

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。Objective In China, injector or cork as a simple stent is often used by radiotherapy physicians in head and neck cancer radiotherapy patients, but it hasn＇t been widely used in clinical because of its poor stability, poor position repeatability and other reasons. This study aims to design and fabricate personalized customized oral positioning stent for radiotherapy of head and neck cancer patients, which can effectively decrease the irradiation dose by allowing part of the normal tissue away from the radiotherapy target and maintaining precise and repeatable stable position. Methods We selected 9 cases of head and neck tumor patients received radiotherapy from march to august 2016 in department of radiotherapy, Nanjing General Hospital of Nanjing Military Region. According to the different location of cancer and plans of radiotherapy, we used the production process of active denture to design and fabricate personalization customization positioning oral stent, took mold, made wax type, filled, polished and so on. Results We successfully produced two kinds of oral positioning stent, mouth opening tongue-depressing stent and mouth opening tongue-backward stent. The mouth opening tongue-depressing stent consists of a spatula and an open dike. After the stent was placed in the mouth, the upper and lower teeth planes have completely match with the jaw contact surfaces of open dike, then opened the patients. occlusion, formed a cavity between the upper and lower jaw, the tongue was always under the spatula, then we could directly see the uvula and retropharyngeal wall of the patients. The mouth opening tongue-backward stent consists of a plate that pushes the tongue backwards and upwards and an open dike. After wearing the oral stent, the distance between the tongue, mouth floor, mandibular and other soft and hard tissue and high dose area of radiotherapy was father than not wearing a stent. Conclusion Wearing personal

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 

分 类 号：R739.6[医药卫生—肿瘤]