目的：通过实时透视食管超声下置入的钛夹位移，评估食管病灶内扩边的影响因素及变化规律。方法对60例食管癌患者，食管超声探察病灶，病灶的上下端置入金属钛夹做基准标记，在模拟放疗体位下直接采集透视图像分析，分别记录平静呼吸和屏气状态下钛夹的空间位移。结果60例患者完成试验，74个病灶，137枚钛夹被置入。透视观察到134个（97．8％），钛夹脱落中位时间为23天，无Ⅲ度以上钛夹置入相关性不良反应。钛夹运动呈规律性振动，振动频率与呼吸运动和心脏搏动相关。在平静呼吸状态下，钛夹移动的极值和中值分别为：头脚方向：（0．7～14．0 mm，7．5 mm）、左右方向（0．4～5．6 mm，2．0 mm）、前后方向（0．6～9．0 mm，2．3 mm）；在屏气状态下，钛夹移动的极值和中值分别为：头脚方向（0．2～3．3 mm，1．5 mm）、左右方向（0．2～3．3 mm，1．1 mm）、前后方向（0．3～3．7 mm，1．5 mm）。结论呼吸运动、心脏搏动、食管病灶位置影响食管病灶内扩边值，其中呼吸运动是主要因素。食管超声钛夹基准标记下的实时透视技术，安全可靠。%Objective To evaluate the factors and changes of esophageal tumor internal margin using real-time perspec-tive esophageal ultrasound implanted titanium clip displacement.Methods 60 patients with esophageal carcinoma underwent the titanium clips placement under EUS-guidance,A fluoroscopic real-time tumor-tracking radiotherapy system was used to monitor the titanium clips.The data of three-dimensional displacement of titanium clips in eupnea and breath-holding conditions were re-corded.Results 60 patients had endoscopic clips placed,a total of 137 fiducial clips was placed on the 74 tumors.134 clips were identified(97.8%) .The median time from clips placement to shedding was 23 days.Toxicity above grade III was not observed. The movement of titanium clips showed regularity of the mobile and mechanical vibration.The vibration frequency was correlated with respiratory motion and cardiac motion.In the eupnea condition,the extremum and median of titanium clips’ peak-to-peak displacements were superior-inferior(0.7~14.0 mm,7.5 mm)、right-left(0.4~5.6 mm,2.0 mm)、anterior-posterior(0.6~9.0 mm,2.3 mm),respectively;In the breath-holding condition,which were superior-inferior(0.2~3.3 mm,1.5 mm)、right-left (0.2~3.3 mm,1.1 mm)、anterior-posterior(0.3~3.7 mm,1.5 mm) ,respectively.Conclusion Respiratory movement,heart throb,location of esophageal lesions affect esophageal tumor internal margin,and respiratory movement is the main factor.Esopha-geal ultrasound titanium clips under real-time perspective is safe and reliable.
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