电磁定位引导巴马小型猪肾穿刺的实验研究
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摘要
目的通过对比电磁定2导航和CT引导下经皮肾脏精准穿刺的动物实验研究,探索电磁定位导航在肾肿瘤穿刺定位中的可行性。方法选取4只巴马小型猪,麻醉后在超声引导下在小型猪的两侧肾脏皮质内分别植入4颗粒子空壳,作为穿刺目标。分别应用电磁定位导航和CT引导方法进行肾脏内粒子空壳穿刺,通过CT扫描验证是否穿中目标,同时收集两种方法的一次性穿中目标次数、穿刺进针次数、CT扫描次数,及电磁定位组的配准误差。结果电磁定位导航组经皮肾穿刺前13次的配准精度误差为(1.201±0.078) mm,一次性穿刺准确率为84.4%,明显大于CT引导组一次性穿刺准确率21.9%,差异有统计学意义(P<0.01);穿刺进针次数电磁定位导航组[(1.16±0.37)次]较CT引导组[(2.84±1.37)次]少,差异有统计学意义(P<0.01);扫描次数电磁定位导航组(2.16±0.37)次较CT引导组(3.84±1.37)次少,差异有统计学意义(P<0.01)。结论电磁定位引导肾脏穿刺定位可增加一次性穿刺成功率,减少穿刺次数,降低辐射剂量。动物实验证实了电磁定位辅助经皮肾穿刺的可行性,为进一步临床应用实验奠定了基础。
Objective To explore the feasibility of electromagnetic positioning and navigation in renal tumor puncture.in BA-Ma mini pigs.Methods Four empty seeds were implanted into the renal cortex of four BA-Ma mini pigs by ultrasound-guide electromagnetic positioning and navigation as well as CT-guided method,which were used as puncture target in the kidneys, respectively,and CT scan was used to verify whether the targets were hit. Moreover, the number of one-time puncture, the number of punctures, the number of CT scans and registration errors in electromagnetic positioning and navigation group were observed and compared.Results The registering precision error before percutaneous renal puncture in electromagnetic positioning and navigation group was(1.201±0.078)mm. The accuracy rate of one-time puncture in electromagnetic positioning and navigation group was 84.4%,which was significantly higher than that(21.9%) in CT-guided group(P<0.01). The number of punctures in electromagnetic positioning and navigation group(1.16±0.37) was lower than that(2.84±1.37) in CT-guided group(P<0.01). The number of CT scans in electromagnetic positioning and navigation group(2.16±0.37)was lower than that(3.84±1.37) in CT-guided group(P<0.01).Conclusion Electromagnetic positioning-guided renal puncture location can improve the successful rate of one-time puncture, reduce the number of punctures and reduce the radiation dose. Its feasibility is confirmed by animal experiment, which lays a foundation for clinical application.
Objective To explore the feasibility of electromagnetic positioning and navigation in renal tumor puncture.in BA-Ma mini pigs.Methods Four empty seeds were implanted into the renal cortex of four BA-Ma mini pigs by ultrasound-guide electromagnetic positioning and navigation as well as CT-guided method,which were used as puncture target in the kidneys, respectively,and CT scan was used to verify whether the targets were hit. Moreover, the number of one-time puncture, the number of punctures, the number of CT scans and registration errors in electromagnetic positioning and navigation group were observed and compared.Results The registering precision error before percutaneous renal puncture in electromagnetic positioning and navigation group was(1.201±0.078)mm. The accuracy rate of one-time puncture in electromagnetic positioning and navigation group was 84.4%,which was significantly higher than that(21.9%) in CT-guided group(P<0.01). The number of punctures in electromagnetic positioning and navigation group(1.16±0.37) was lower than that(2.84±1.37) in CT-guided group(P<0.01). The number of CT scans in electromagnetic positioning and navigation group(2.16±0.37)was lower than that(3.84±1.37) in CT-guided group(P<0.01).Conclusion Electromagnetic positioning-guided renal puncture location can improve the successful rate of one-time puncture, reduce the number of punctures and reduce the radiation dose. Its feasibility is confirmed by animal experiment, which lays a foundation for clinical application.
引文
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23 Geneser SE,Hinkle JD,Kirby RM,et al.Quantifying variability in radiation dose due to respiratory-induced tumor motion.Medical Image Analysis,2011,15:640-649.
24 Xu Q,Xie K,Yuan K,et al.A statistical study of the factors influencing the extent of respiratory motion blur in PET imaging.Computers in Biology & Medicine,2012,42:8.
25 Davies SC,Hill AL,Holmes RB,et al.Ultrasound quantitation of respiratory organ motion in the upper abdomen.Br J Radiol,1994,67:1096-1102.
26 习勉,刘孟忠,李巧巧,等.基于4DCT的腹部器官呼吸运动分析.癌症,2009,28:989-993.
27 王侦艺.肺癌放疗中胸部热塑体膜与负压真空气垫在改善患者固定摆位误差中的效果比较.医疗装备,2017,30:19-20.
2 Lee KA,Raval AA,Amir L.Cost-effectiveness of endobronchial percutaneous biopsy compared with transthoracic biopsy for diagnosis of peripheral lung lesions.Lung Cancer Management,2014,3:135-148.
3 陈永成.四维(4D)电磁导航如何提高工作效率和准确度.医疗装备,2015,28:3-5.
4 包建孟,胡超,林卫星,等.电磁定位系统设计.现代仪器与医疗,2014,20:11-14.
5 Gilbert C,Akulian J,Ortiz R,et al.Novel bronchoscopic strategies for the diagnosis of peripheral lung lesions:present techniques and future directions.Respirology,2014,19:636-644.
6 Chen A,Pastis N,Furukawa B,et al.The effect of respiratory motion on pulmonary nodule location during electromagnetic navigation bronchoscopy.Chest Journal,2015,147:1275-1281.
7 张丽云.CT四维电磁导航引导下 125I放射性粒子植入治疗脊柱转移瘤伴脊髓压迫的临床研究.苏州大学,2016.
8 陈永佳,张佳田,潘知常,等.电磁导航交锁髓内钉在胫骨干骨折中的应用.中国骨与关节损伤杂志,2017,32:407-408.
9 曹春艳,胡正云,陈博.不同麻醉方法在幼龄贵州小型猪构建颅骨缺损模型及修复术中麻醉效果的比较.中国比较医学杂志,2017,27:41-45.
10 段天兵,张金霞,向定成,等.复合麻醉对五指山小型猪长达8小时实验的麻醉效果观察.中国比较医学杂志,2018,28:84-85.
11 Lin HC,Walz P,Lin HC,et al.Farm animal anesthesia:cattle,small ruminants,camelids,and pigs.Farm Animal Anesthesia,2014,39:755-761.
12 Beckman B.Anesthesia and pain management for small animals.Veterinary Clinics of North America Small Animal Practice,2013,43:669-688.
13 张丙新.胸腹部肿瘤放疗3种摆位方法的综合比较.医疗卫生装备,2011,32:64-64.
14 李海涛.微波消融在早期肾脏肿瘤治疗中的应用.上海交通大学,2015.
15 Floridi C,De BI,Fontana F,et al.Microwave ablation of renal tumors:state of the art and development trends..Radiol Med,2014,119:533-540.
16 Zhang M,Liang P,Cheng ZG,et al.Efficacy and safety of artificial ascites in assisting percutaneous microwave ablation of hepatic tumours adjacent to the gastrointestinal tract.Int J Hyperthermia,2014,30:134-141.
17 Katsanos K,Mailli L,Krokidis M,et al.Systematic review and meta-analysis of thermal ablation versus surgical nephrectomy for small renal tumours.Cardiovasc Intervent Radiol,2014,37:427-437.
18 黄建林,陈吉东,廖勇,等.超声引导经皮微波消融治疗肾癌根治术后局部复发5例分析.现代泌尿外科杂志,2017,22:33-36.
19 Thomas AZ,Adibi M,Borregales LD,et al.Surgical management of local retroperitoneal recurrence of renal cell carcinoma after radical nephrectomy.J Urol,2015,194:316-322.
20 Caputo PA,Ramirez D,Zargar H,et al.Laparoscopic cryoablation for renal cell carcinoma:100-month oncologic outcomes,a single institu-tion’s experience.J Urol,2015,194:892-896.
21 Zargar H,Samarasekera D,Khalifeh A,et al.Laparoscopic vs Percutaneous Cryoablation for the Small Renal Mass:15-Year Experience at a Single Center.Urology,2015,85:850-855.
22 潘杰,陈绍辉,卢欣,等.全麻下CT引导下经皮穿刺射频消融治疗肝内特殊部位的恶性肿瘤.介入放射学杂志,2010,19:478-481.
23 Geneser SE,Hinkle JD,Kirby RM,et al.Quantifying variability in radiation dose due to respiratory-induced tumor motion.Medical Image Analysis,2011,15:640-649.
24 Xu Q,Xie K,Yuan K,et al.A statistical study of the factors influencing the extent of respiratory motion blur in PET imaging.Computers in Biology & Medicine,2012,42:8.
25 Davies SC,Hill AL,Holmes RB,et al.Ultrasound quantitation of respiratory organ motion in the upper abdomen.Br J Radiol,1994,67:1096-1102.
26 习勉,刘孟忠,李巧巧,等.基于4DCT的腹部器官呼吸运动分析.癌症,2009,28:989-993.
27 王侦艺.肺癌放疗中胸部热塑体膜与负压真空气垫在改善患者固定摆位误差中的效果比较.医疗装备,2017,30:19-20.