3D打印共面模板辅助放射性粒子植入治疗恶性肿瘤剂量学研究

目的 对比3D打印共面模板辅助放射性粒子植入治疗恶性肿瘤的术前与术后剂量学结果，探讨该技术在粒子植入治疗中的精确性。方法 选取2015年11月至2016年12月于山东省滕州市中心人民医院实施3D打印共面模板辅助粒子植入患者32例，植入病灶36个：包括肺部10个、颈部淋巴结5个、盆腔3个、椎体3个、胰腺2个、腹腔淋巴结2个、门静脉2个、其余9个。所有患者行术前计划设计，在共面模板引导下一次性完成所有层面的进针，依据术前计划植入粒子，行术后剂量学评估。对比术前、术后剂量学参数，包括90%和100%靶体积的最小吸收剂量D₉₀和D₁₀₀，90%、100%、150%和200%处方剂量覆盖的体积V₉₀、V₁₀₀、V₁₅₀和V₂₀₀，适形指数（CI）、靶区外体积指数（EI）和均匀性指数（HI）。统计学采用配对 t 检验。结果 全部病灶、运动病灶和固定病灶植入前后D₉₀、D₁₀₀、V₉₀、V₁₀₀、V₁₅₀、V₂₀₀、CI、EI和HI等指标参数配对 t检验，各指标手术前后比较差异均无统计学意义（P>0.05）。结论 3D打印共面模板引导粒子植入剂量指标术前与术后比较无差别，对于固定和运动脏器肿瘤，有良好的治疗准确性，可能成为未来粒子植入重复性好的标准术式。

Dosimetry verification of radioactive seed implantation for malignant tumor assisted by 3D-printing coplanar template

Objective To compare the dose distribution of postoperative plans with preoperative plans for 3D printing coplanar template assisted radioactive seed implantation,and to explore the accuracy of the technique in seed implantation. Methods From November 2015 to December 2016 a total of 32 patients were selected and underwent 3D printing coplanar template assisted radioactive seed implantation in Tengzhou Central People''s Hospital of Shandong province. There were 36 implanted lesions,including 10 in the lungs,5 in neck lymphs,3 in pelvic cavities,3 in vertebral body,2 in pancreas,2 in abdominal lymph nodes,2 in portal veins,and 9 in the other parts. All patients were given preoperative planning and guided by the coplanar templates. Compared with the preoperative plan, all levels needles inserted at the same time. According to preoperative planning the implantation surgery was completed accurately. The postoperative dosimetry was evaluated. The preoperative and postoperative dosimetry parameters were compared, including D₉₀,D₁₀₀,V₉₀,V₁₀₀, V₁₅₀,V₂₀₀ and conformal index(CI),external index(EI),and homogeneity index(HI). The paired t test was used to perform the statistical analysis.Result There was no significant differences in D₉₀,D₁₀₀,V₉₀,V₁₀₀, V₁₅₀, V₂₀₀, CI, EI and HI between before and after operation(P>0.05). Conclusions The dose parameters in postplan showed no difference compared with preplan in this study. For fixed and moving organ tumors,3D printing coplanar template assisted radioactive seed implantation has good therapeutic accuracy,and may be a standardized surgicalmethod for seed implantation in the future.