摘要
目的对比定量定时饮水与膀胱灌注方式在宫颈癌术后调强放疗的摆位误差与充盈效果,为临床提供参考。方法选取2018-09-03-2019-05-31中山大学附属第一医院22例术后宫颈癌放疗患者,根据CT定位前是否留置导尿管,分为A、B 2组各11例。A组不留置导尿管,饮水750 mL等待有一定尿感后进行CT定位并记录时间;B组由护士经导尿管侧腔末端进行膀胱灌注250 mL生理盐水,确保无渗漏后定位。每次放疗前进行同样操作,每周1次锥束断层影像(CBCT),记录摆位误差并计算膀胱体积,以及治疗与定位的膀胱体积比R。R值在0.5~1.5为充盈较准,R>1.5或R<0.5分别为充盈过度或不足。采用SPSS 17.0进行数据统计学分析,计算摆位误差、膀胱体积和膀胱体积比,符合正态分布的数据采用配对t检验分析,否则采用非参数对应的检验方法。结果 2组22例患者共收集110套CBCT影像,A组x(左右)、y(头脚)、z(前后)3个方向的摆位误差分别为(-0.4±2.2)、(-0.6±3.6)和(0.4±2.0) mm,B组分别为(-0.8±2.5)、(0.1±3.0)和(0.6±2.0) mm,2组差异无统计学意义,t值分别为1.034、-1.113和-0.591,P值分别为0.399、0.092和0.910;A、B组定位CT膀胱体积分别为(308±32)和(325±48) mL,差异无统计学意义,t=1.007,P=0.326;治疗与定位的膀胱体积比值R分别为0.65±0.33和0.87±0.20,差异有统计学意义,t=4.218,P<0.001;R值概率分布<0.5、0.5~1.5、>1.5,A、B组分别为0.328、0.636、0.036和0.036、0.964、0。结论膀胱充盈准确性对术后宫颈癌精准放疗有重要意义,膀胱灌注对比定量定时饮水的充盈准确性较佳,摆位误差无差异,膀胱灌注可以应用于临床。
Objective To compare the set-up errors and filling effects of quantitative regular drinking water to those of bladder perfusion in intensity-modulated radiotherapy patients with postoperative cervical cancer,so as to provide reference for clinical practice.Methods A total of 22 radiotherapy patients with postoperative cervical cancer in First Affiliated Hospital of Sun Yat-sen University from September 3,2018 to May 31,2019 were selected.According to whether the catheter was placed before CT-simulation,the patients were divided into two groups with 11 cases in each group.Patients in group A without indwelling catheter drank 750 ml water to wait for a certain sense of urination before CT-simulation and recorded the time;patients in group B were perfused with 250 ml normal saline through the end of urinary catheter side cavity by nurse to ensure no leakage.The same operation was performed before each radiotherapy,cone beam computed tomography(CBCT) was performed once a week,and the set-up error was recorded.The bladder volume and the ratio of bladder volume between treatment and simulation was calculated.The value of R between 0.5 and 1.5 was considered as the filling accuracy,and R>1.5 or R<0.5 was regarded as overfilling or insufficient respectively.SPSS 17.0 was used for statistical analysis,including set-up error,bladder volume and ratio of bladder volume,and normal distribution test was conducted.If Shapiro-Wilk results were in accordance with normal distribution,paired t-test was used,otherwise non parametric corresponding test method was used.Results There were 22 patients in the two groups,and 110 sets of CBCT images were collected.The set-up errors of x(Left-right), y(Superior-inferior) and z(Anterior-posterior) in group A were(-0.4±2.2),(-0.6±3.6) and(-0.4±2.0) mm respectively,and those in group B were(-0.8±2.5),(-0.1±3.0) and(0.6±2.0) mm.The t values were 1.034,-1.113,-0.591 and the P values were 0.399,0.092 and 0.910,respectively.The difference was not statistically significant in set-up error between the two groups.The bladder volume of CT in group A and group B were(308±32)and(325±48)ml.The t value was 1.007.The difference was not statistically significant(P=0.326).The volume ratio were(0.65±0.32)and(0.87±0.20).The t value was 4.218.The difference was statistically significant(P<0.001).The probabilities in group A and group B of R<0.5,0.5≤R≤1.5,R>1.5 were0.328,0.636,0.036 and 0.036,0.964,0.Conclusions The accuracy of bladder filling is of great significance to the precise radiotherapy of postoperative cervical cancer.The filling accuracy of bladder perfusion is better than quantitative regular drinking,and there is no difference in set-up error.Bladder perfusion can be used in clinical.
作者
钟嘉健
丘敏敏
邓永锦
张榕
任玉峰
ZHONG Jia-jian;QIU Min-min;DENG Yong-jin;ZHANG Rong;REN Yu-feng(Department of Radition Oncology,Affiliated First Hospital,Sun Yat-sen University,Guangzhou 510080,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2021年第12期944-948,共5页
Chinese Journal of Cancer Prevention and Treatment
关键词
膀胱充盈度
摆位误差
宫颈肿瘤
图像引导放疗
bladder filling status
set-up error
cervical neoplasms
image-guided radiotherapy
