数字化外科技术在^(125)I粒子植入治疗头颈深部肿瘤中的应用  

Application of digital surgical techniques in radioactive ^(125)I seed implantation for brachytherapy of deep head and neck tumors

作　　者：张国昊 黄明伟[1] 郑磊[1] 吕晓鸣 伍文杰 张益[1] 张建国[1] Zhang Guohao;Huang Mingwei;Zheng Lei;Lyu Xiaoming;Wu Wenjie;Zhang Yi;Zhang Jianguo(Department of Oral and Maxillofacial Surgery,Hospital of Stonatology,Peking University,National Clinical Research Center for Oral Diseases,Natinal Enginering Laboratory of Dental Digital Medical Technology and Materials,Beijing Key Laboratory of Dental Digital Medicine,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,100081

出　　处：《中华放射医学与防护杂志》2021年第1期14-18,共5页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的探索和评价数字化外科技术用于引导^(125)I粒子植入治疗头颈深部肿瘤的精确性、适形性和临床应用价值。方法回顾性选取12例行^(125)I放射性粒子近距离放疗的头颈深部肿瘤患者。治疗前基于CT图像设计插植针和粒子位置。根据治疗计划构建数字化定位模型将计划的插植针位置精准导入至手术导航系统,并根据患者面部外形轮廓和插植针位置方向设计打印个体化穿刺引导模板。术中在导航引导下进行模板核准就位,在导航系统的可视化针道、实时插植针位置和模板导向孔共同引导下进行插植针穿刺和放射性粒子植入。CT检查验证插植针与粒子的位置,并计算实际靶区剂量分布,观察术中及术后是否出现血肿、疼痛、感染、穿刺点不愈合、肿瘤细胞种植等不良反应。结果12例患者均在数字化外科技术引导下完成插植针穿刺和放射性粒子植入,实时可视化引导效果佳,插植针、粒子与治疗计划中的位置、数目相符,空间分布均匀。术后剂量验证D90范围为83.7~131.0 Gy,平均107.5 Gy;V100范围为89.6%~99.3%,平均94.6%;V150范围为40.2%~58.9%,平均47.8%。术中术后未出现严重不良反应。结论采用数字化外科技术,将手术导航系统与3D打印个体化穿刺引导模板结合共同引导插植针穿刺和^(125)I粒子植入,提高了近距离放疗的精确性和适形性,在头颈部近距离放疗特别是深部解剖结构复杂区具有临床应用价值。Objective To explore and evaluate the accuracy,conformity,and clinical application value of digital surgical techniques in guiding ^(125)I seed implantation in the brachytherapy of deep head and neck tumors.Methods Twelve patients with deep head and neck tumors who received brachytherapy of radioactive ^(125)I seed implantation were selected for the study.The locations of the implantation needles and seeds were designed based on CT images before the operation.A digital positioning model was built according to the treatment plan to accurately import the planned locations of implantation needles into the surgical navigation system.Meanwhile,an individualized puncture guidance template was designed and printed according to the patients'facial profiles as well as the locations and directions of the implantation needles.During the operation,the template was put in place under the guidance of the navigation system and meanwhile,the implantation needle puncture and radioactive seed implantation were conducted under the joint guidance of the visual needle path and real-time implantation needle locations in the navigation system and template guidance holes.The locations of the implantation needle and the seeds were validated by CT scan and the dose distribution in target areas was calculated.Adverse reactions such as hematoma,pain,infection,nonunion of puncture sites,and tumor cell implantation were observed during and after the operation.Results All 12 patients successfully received implantation needle puncture and radioactive seed implantation under the guidance of the digital surgical techniques,achieving excellent effects of real-time visualization guidance.Meanwhile,the locations and number of the implantation needles and seeds were consistent with the treatment plan and were distributed evenly.Furthermore,according to postoperative verification,D90 ranged from 83.7 Gy to 131.0 Gy,with an average of 107.5 Gy;V100 was 89.6%-99.3%,with an average of 94.6%,and V150 ranged from 40.2%to 58.9%,averaging 47.8%.No serious ad

关 键 词：近距离放疗 头颈部肿瘤 导航 3D打印 个体化穿刺引导模板 

分 类 号：R739.91[医药卫生—肿瘤]