宫颈癌盆腔外周型复发行放射性粒子治疗的植入 穿刺 路径与技巧  

Radioactive 125 I seed implantation on pelvic peripheral recurrent cervical cancer:discussion on its puncture approach and skills

作　　者：乔伟[1] 张秀明[1] 郭文杰[2] 郭昌 冯勇[2] QIAO Wei;ZHANG Xiuming;GUO Wenjie;GUO Chang;FENG Yong(Jiangsu Cancer Hospital/Jiangsu Institute of Cancer Research/Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;Department of Radiotherapy,Jiangsu Cancer Hospital/Jiangsu Institute of Cancer Research/Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院影像中心,江苏南京210009 [2]江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院放疗科,江苏南京210009

出　　处：《中国肿瘤外科杂志》2023年第4期356-362,共7页Chinese Journal of Surgical Oncology

基　　金：南京医科大学“专病队列”研究项目(NMUC2020033)。

摘　　要：目的探讨宫颈癌盆腔外周型复发行CT引导下放射性125 I粒子植入治疗穿刺进针路径的设计、辅助技术的应用及安全性。方法对江苏省肿瘤医院自2019年1月至2021年12月共23例宫颈癌盆腔外周型复发病灶行CT引导下放射性125 I粒子植入治疗病例进行回顾性研究,分析穿刺进针路径、相关辅助技术、物理剂量学参数及手术并发症,探讨放射性125 I粒子植入治疗宫颈癌盆腔外周型复发的可行性、安全性及技巧性。结果23例宫颈癌盆腔外周型复发病例共23个病灶,均顺利完成CT引导下放射性125 I粒子植入治疗。穿刺路径分为经前腹壁髂腰肌入路(7例)、经前腹壁腹腔入路(3例)、经前腹壁髂腰肌入路联合经前腹壁腹腔入路(1例)、经骶骨旁梨状肌入路(7例)、经尾骨旁臀大肌入路(3例)及侧卧位前后双路径联合入路(2例)。应用相关辅助技术包括使用穿刺角度引导器辅助进针(18例);使用4D模板辅助进针(5例);腹腔内进针过程中推注生理盐水(2例);粒子植入术前行输尿管“J”管植入(10例);粒子植入术中静脉推注造影剂显示输尿管(1例);粒子植入术中应用钝针技术(3例)。比较术前、术后肿瘤病灶体积、针数、粒子数、剂量学参数差别,剂量学参数包括90%靶区体积剂量(D_(90)),匹配周边剂量(mPD,即D 100),90%、100%、150%和200%处方剂量体积百分比(V_(90)、V_(100)、V_(150)和V_(200)),适形指数(CI),靶区外体积指数(EI)和均匀性指数(HI)。术后中位病灶体积22.60 cm 3,中位针数6根,中位粒子数35颗,均较术前差异有统计学意义(P<0.05)。术后剂量评估V 200较术前计划低(33.00%vs.35.20%,t=2.143,P=0.043);术后HI较术前增大(39.97%vs.35.06%,t=-2.793,P=0.011);其余剂量学参数术前计划与术后验证差异无统计学意义(P>0.05)。23例术后均无明显并发症发生。结论宫颈癌盆腔外周型复发行CT引导下放射性125 I粒子植入治疗是安全可行的,设计Objective To explore the design of needle insertion path,application and safety of assistive technology for CT-guided radioactive 125 I seed implantation on pelvic peripheral recurrent cervical cancer.Methods A total of 23 cases of cervical cancer with pelvic peripheral treated by CT-guided radioactive 125 I seed implantation were retrospectively studied,and the puncture path,related assistive technologies,physical dosimetry parameters and surgical complications were analyzed.o investigate the feasibility,safety and technique of radioactive 125 I seed implantation in the treatment of cervical cancer with pelvic peripheral recurrent.Results 23 cases of cervical cancer with pelvic peripheral recurrent were successfully treated with radioactive 125 I seed implantation under CT guidance.The puncture path was divided into anterior abdominal iliopsoas approach(7 cases),anterior abdomina approach(3 cases),anterior abdominal iliopsoas approach combined with anterior abdominal abdominal approach(1 case),paracrum piriformis approach(7 cases),parcoccygeal gluteus maximus approach(3 cases)and lateral decubitus combined approach(2 cases).The application of related assistive techniques included needle insertion assisted by puncture angle guide(18 cases);4D template assisted needle insertion(5 cases);push injection of normal saline during intraperitoneal needle insertion(2 cases);ureteral"J"tube implantation before particle implantation(10 cases);ureter showed by intravenous injection of contrast agent during particle implantation(1 case);application of blunt needle technique in particle mplantation(3 cases).The differences of tumor volume,needle number,particle number and dosimetry parameters between preoperative and postoperative were compared.The dosimetry parameters included dose of 90%target volume(D_(90)),mPD,volume percent of 90%,100%,150%and 200%prescribed dose(V_(90)、V_(100)、V_(150),V_(200)),conformal index(CI),target area external index(EI),homogeneity index(HI).The median postoperative volume of lesion was 22.60c

关 键 词：宫颈癌 复发 粒子植入 技巧 剂量 

分 类 号：R737.33[医药卫生—肿瘤]