肾上腺肿块病变的运动规律及影响因素的临床研究

目的 探讨肾上腺肿块病变的运动规律、幅度大小及其影响因素,为实施立体定向放射治疗时确定计划靶区（PTV）提供参考依据.方法 38例转移肾上腺肿瘤病人采用B超下穿刺的方法将1～2个金标植入肾上腺肿瘤瘤体内,并在模拟定位机下对金标的运动幅度进行测量,得出其在病人身体左右（x轴）、前后（y轴）、头脚（z轴）方向的移动幅度,用多元线性回归模型分析影响因素.采用t检验对（左、右肾上腺病灶在）z轴方向上的运动幅度进行比较.结果 38例病人肾上腺内的金标在x轴方向的移动距离为0.1～0.4 cm（0.27±0.07） cm],y轴方向为0.1～0.5 cm（0.31±0.11） cm],z轴方向为0.5～1.2 cm（0.87±0.21） cm].z轴方向上病灶的运动幅度可能仅受到病灶位置的影响（P=0.002）,其余方向未显示运动幅度受年龄、身高、体质量、病灶位置、大小的影响.比较z轴上不同病灶位置的运动幅度,左、右肾上腺病灶分别为（0.99±0.22） cm和（0.79±0.16） cm,右肾上腺病灶的运动幅度较左肾上腺病灶小（t=4.08,P=0.000）.结论 肾上腺肿块病变的移动受呼吸运动影响,在z轴方向上的移动距离最大,在确定PTV安全边界时应主要考虑其在z轴方向的移动.同时右肾上腺因肝脏的限制,其运动幅度较左肾上腺的要小.

The motion amplitude of the adrenal occupying lesions and its influencing factors

Objective To investigate the motion amplitude of adrenal lesions and its influencing factors providing a reference for planning target volume （PTV） of stereotactic radiotherapy. Methods One to two gold fiducial markers were implanted into adrenal tumors under ultrasound guide in 38 patients with adrenal metastasis. The movements of the gold fiducials in orthogonal directions left-right （x-axis）, anterior-posterior （y-axis） and cranio-caudal （z-axis）] were measured with simulator machine. The multiple linear regression model was used to analyze influencing factors and the Student t test was used to compare the movement along the z-axis. Results Moving distance in the x -axis was of 0.1 - 0.4 cm （0.27± 0.07） cm], 0.1 ± 0.5cm （0.31 ± 0.11） cm] in the y -axis, 0.5 - 1.2 cm （0.87 ± 0.21） cm] in the z -axis. The motion amplitude of the lesions in the z-axis was affected by the location of the lesion. In the other directions, the amplitude of motion was not affected by age, height, body mass, location, and size of lesion. The motion amplitude of right side was significantly smaller than that of left side in the z-axis （0.79 ± 0.16 cm vs. 0.99 ± 0.22 cm, t=4.08, P=O.O00）. Conclusion The movement of adrenal lesions is affected by respiratory motion, especially in the cranio-caudal direction. The adrenal motion is smaller in fight than in the left, due to presence of the liver. The movement of adrenal lesion in the eranio-caudal direction should be considered when determining the safety margin of PTV.