肝脏占位性病变的运动规律及其影响因素的初步临床研究

摘要

Objective To investigate the movement,and the factors that influence such movement of liver lesions and to provide a reference for determination of internal target volume (ITV) during stereotactic radiotherapy. Methods We implanted 1 -2 gold markers into or near the liver tumors of 42 liver primary or metastasis cases percutaneously under B-ultrasound or computer tomography (CT) guidance. The marked motion of liver lesions in x ( right-left), y (superior-inferior) and z (anterior-posterior) directions was measured via X-ray simulator system. Based on the statistical analysis of the detected movements, we investigated the relevant influencing factors of liver lesions with bivariate correlation analysis. Results Data showed that mean motion amplitudes of liver lesions were 0.27 ± 0. 11 cm (0. 1 -0. 5cm) in x direction,0.38 ±0. 19 cm (0. 1 -0. 8cm) in y direction and 1.19 ±0. 27 cm (0. 5 - 1.9cm) in z direction. Motion amplitude was not correlated with the height, weight or age of the patients nor with the location or size of the tumor. Conclusions Motion of liver lesions was mainly influenced by the respiratory and has maximal amplitude in the z direction. Therefore,the motion in the z direction should be given a priority consideration while determining the ITV.%目的 探讨肝脏占位性病变的运动规律及其影响因素,为其在精确放疗时确定内靶区提供参考价值.方法 42例原发或转移肝脏肿瘤患者采用B超或CT引导下穿刺的方法将1～2个纯金标记置入肝脏肿瘤体内或邻近位置,并在X线模拟定位机下对标记的运动幅度进行测量.得出其在患者身体左右、前后、头脚方向移动数据,同时采用双变量相关分析影响其运动的因素.结果 42例患者体内标记在头脚方向的移动距离为(1.19±0.27)cm(0.5～1.9 cm),左右方向的为(0.27±0.11)cm(0.1～0.5 cm),前后方向的为(0.38±0.19)cm(0.1～0.8 cm).统计结果显示其移动距离与患者年龄、身高、体重、肿瘤位置和大小无关.结论 肝脏占位性病变的移动主要受呼吸运动影响,且在头脚方向的移动距离最大,在确定内靶区时应主要考虑其在头脚方向的移动.