四维电磁导航系统辅助CT引导下肝肿瘤热消融的临床应用
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摘要
目的探讨肝肿瘤热消融过程中四维电磁导航系统在辅助CT引导的应用价值和疗效评估。方法选择40例需接受单针热消融的单发肝肿瘤患者(肿瘤最大直径≤5 cm),采用随机数字表的方法将40例患者随机分为两组,其中20例患者(导航组)行四维电磁导航系统辅助CT引导下肝肿瘤热消融,20例患者(对照组)在常规CT引导下行肝肿瘤热消融。记录并比较两组患者热消融过程中的皮肤穿刺次数,针调整次数,穿刺靶目标时间,CT扫描次数,CT透视时间和总剂量乘积(DLP)。观察两组患者热消融术后并发症的情况,并在术后1～2个月随访热消融的效果。结果导航组20例患者在肝肿瘤热消融的过程中成功应用四维电磁导航系统,导航组与对照组患者的皮肤穿刺次数比为(1.20±0.42)次比(1.25±0.55)次,P=0.803;针调整次数为(2.40±1.17)次比(4.95±3.10)次,P=0.003;穿刺靶目标的时间为(16.50±10.62)min比(15.20±5.82)min,P=0.725;CT扫描次数为(7.10±1.73)次比(10.30±4.09)次,P=0.006;CT透视时间为(40.47±18.71)s比(59.98±32.23)s,P=0.046;CT透视时间和总剂量乘积(DLP)为(807.39±284.79)m Gy·cm比(1 578.67±784.00)m Gy·cm,P=0.001。在热消融的过程中40例患者均无严重并发症发生,术后1～2个月随访复查导航组和对照组患者的完全消融率为90.0%和84.2%(P>0.05)。结论四维电磁导航系统辅助CT引导下肝肿瘤热消融可明显减少热消融过程中消融针调整次数,CT扫描次数和CT透视时间,同时可大大降低患者接受的辐射剂量。但仍需要进一步的研究来确定四维电磁导航系统的应用效果。
Objective To discuss the application of four-dimensional(4D) electromagnetic navigation system in assisting CT-guided thermal ablation therapy of liver tumors, and to evaluate its curative effect.Methods A total of 40 patients with solitary liver tumor(tumor maximum diameter ≤5 cm), who needed to receive single-needle thermal ablation therapy, were equally and randomly divided into navigation group and control group by using a random number table. CT-guided thermal ablation therapy with the help of 4D electromagnetic navigation system was carried out in the patients of navigation group(n =20), while conventional CT-guided thermal ablation therapy was employed in the patients of control group(n=20). The number of skin puncturing, the number of needle puncturing adjustment, the time taken to puncture a target,the number of CT scanning, the CT fluoroscopic time and the total dose-length product(DLP) were recorded and the results were compared between the two groups. The postoperative complications of thermal ablation were documented, and the curative effect of thermal ablation was eval uated in 1-2 months after treatment.Results During the whole process of treatment, 4D electromagnetic navigation system successfully assisted the performance of thermal ablation procedure in all the 20 patients of the navigation group. Compare the navigation group with the control group, the number of skin puncturing was(1.20±0.42) vs(1.25±0.55) with P=0.803, the number of needle puncturing adjustment was(2.40±1.17) vs(4.95±3.10) with P=0.003, the time taken to puncture a target was(16.50±10.62) min vs(15.20±5.82) min with P=0.725, the number of CT scanning was(7.10±1.73) vs(10.30±4.09) with P=0.006, the CT fluoroscopic time was(40.47±18.71)seconds vs(59.98±32.23) seconds with P=0.046, and the total DLP was(807.39±284.79) m Gy·cm vs(1 578.67±784.00) m Gy·cm with P=0.001. No serious complications occurred during the process of thermal ablation in all 40 patients. The patients were followed up for 1-2 months, the complete ablation rates in the navigation group and in the control group were 90% and 84.21% respectively(P>0.05). Conclusion In treating solitary liver tumor with thermal ablation, the use of 4D electromagnetic navigation system can significantly reduce the number of needle puncturing adjustment, the number of CT scanning and the CT fluoroscopic time,thereby remarkably reducing the radiation dose received by patients. However, more studies are needed to further validate the application effect of 4D electromagnetic navigation system.
Objective To discuss the application of four-dimensional(4D) electromagnetic navigation system in assisting CT-guided thermal ablation therapy of liver tumors, and to evaluate its curative effect.Methods A total of 40 patients with solitary liver tumor(tumor maximum diameter ≤5 cm), who needed to receive single-needle thermal ablation therapy, were equally and randomly divided into navigation group and control group by using a random number table. CT-guided thermal ablation therapy with the help of 4D electromagnetic navigation system was carried out in the patients of navigation group(n =20), while conventional CT-guided thermal ablation therapy was employed in the patients of control group(n=20). The number of skin puncturing, the number of needle puncturing adjustment, the time taken to puncture a target,the number of CT scanning, the CT fluoroscopic time and the total dose-length product(DLP) were recorded and the results were compared between the two groups. The postoperative complications of thermal ablation were documented, and the curative effect of thermal ablation was eval uated in 1-2 months after treatment.Results During the whole process of treatment, 4D electromagnetic navigation system successfully assisted the performance of thermal ablation procedure in all the 20 patients of the navigation group. Compare the navigation group with the control group, the number of skin puncturing was(1.20±0.42) vs(1.25±0.55) with P=0.803, the number of needle puncturing adjustment was(2.40±1.17) vs(4.95±3.10) with P=0.003, the time taken to puncture a target was(16.50±10.62) min vs(15.20±5.82) min with P=0.725, the number of CT scanning was(7.10±1.73) vs(10.30±4.09) with P=0.006, the CT fluoroscopic time was(40.47±18.71)seconds vs(59.98±32.23) seconds with P=0.046, and the total DLP was(807.39±284.79) m Gy·cm vs(1 578.67±784.00) m Gy·cm with P=0.001. No serious complications occurred during the process of thermal ablation in all 40 patients. The patients were followed up for 1-2 months, the complete ablation rates in the navigation group and in the control group were 90% and 84.21% respectively(P>0.05). Conclusion In treating solitary liver tumor with thermal ablation, the use of 4D electromagnetic navigation system can significantly reduce the number of needle puncturing adjustment, the number of CT scanning and the CT fluoroscopic time,thereby remarkably reducing the radiation dose received by patients. However, more studies are needed to further validate the application effect of 4D electromagnetic navigation system.
引文
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[5]郝伟远,陈玉堂,邵国良.IG4电磁导航系统辅助CT引导下肺结节穿刺活检术的临床应用[J].介入放射学杂志,2016,25:682-685.
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[9]王忠敏,陈志瑾,李麟荪.CT四维电磁导航在肿瘤微创介入治疗中的应用[J].介入放射学杂志,2014,23:93-95.
[10]Narsule CK,Sales Dos Santos R,Gupta A,et al.The efficacy of electromagnetic navigation to assist with computed tomographyguided percutaneous thermal ablation of lung tumors[J].Innovations(Phila),2012,7:187-190.
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[2]张肖,肖越勇.导航机器人系统在肿瘤微创治疗中的临床应用进展[J].中国介入影像与治疗学,2016,13:111-113.
[3]Chen MH,Yang W,Yan K,et al.Large liver tumors:protocol for radiofrequency ablation and its clinical application in 110patients:mathematic model,overlapping mode,and electrode placement process[J].Radiology,2004,232:260-271.
[4]郑加生,范卫君,胡凯文,等.影像引导肝脏肿瘤热消融治疗技术临床规范化应用专家共识[J].临床肝胆病杂志,2017,33:1864-1869.
[5]郝伟远,陈玉堂,邵国良.IG4电磁导航系统辅助CT引导下肺结节穿刺活检术的临床应用[J].介入放射学杂志,2016,25:682-685.
[6]杨杰,肖越勇,张肖,等.电磁导航系统在CT引导下经皮穿刺肺活检术中的应用[J].中国介入影像与治疗学,2012,9:172-174.
[7]李智,倪才方,李炜,等.基于电磁导航的影像引导系统在膈顶部肝癌消融中的应用[J].介入放射学杂志,2016,25:969-972.
[8]章浙伟,邵国良.影像导航辅助定位穿刺系统在微创介入治疗中的应用[J].介入放射学杂志,2017,26:948-951.
[9]王忠敏,陈志瑾,李麟荪.CT四维电磁导航在肿瘤微创介入治疗中的应用[J].介入放射学杂志,2014,23:93-95.
[10]Narsule CK,Sales Dos Santos R,Gupta A,et al.The efficacy of electromagnetic navigation to assist with computed tomographyguided percutaneous thermal ablation of lung tumors[J].Innovations(Phila),2012,7:187-190.
[11]Santos RS,Gupta A,Ebright MI,et al.Electromagnetic navigation to aid radiofrequency ablation and biopsy of lung tumors[J].Ann Thorac Surg,2010,89:265-268.