摘要
目的为了提高植入效率,减少植入时间以及金标植入带来的痛苦和风险,我们在CT引导下一针植入一颗金标的技术基础上开发了一针植入双金标技术。方法 2011年8月-2012年7月间共有429例肝脏肿瘤患者在射波刀治疗前采用单针双金标技术植入1252颗金标,年龄最小19岁,年龄最大74岁。单针双金标技术是在单针单金标技术的基础上,一次穿刺植入2颗金标。首先利用CT获取肿瘤的影像,确定第一颗金标植入的深度和角度,利用18-G针把第一颗金标植入到指定位置;针芯与针套缓慢拔出3-5cm,并在原位置停留3-5min,然后放入第二颗金标。金标植入完成后,获取金标影像,测量两颗金标之间的距离和连线角度,检查是否符合金标植入原则。结果单针双金标技术植入的1252颗金标中,有18颗(1.44%)金标间距<20 mm,有24颗(1.92%)金标在45°角方向共线,有17颗(1.04%)金标移位到其它器官,成功率达到95.28%。1252颗金标通过单针双金标技术只需要植入626次,效率提高了一倍,穿刺次数减少了一半。结论单针双金标技术使植入效率提高1倍,同时由于穿刺次数减半,不仅降低了成本,也减少了穿刺带来的风险。金标间距<20 mm和45°共线是影响成功率的关键因素,我们需要掌握该技术的操作要点,否则会造成植入金标无法使用。
【Objective】 To improve implanting efficiency and reduce the time required for the implantation and the pain and risks brought by it,we invented a technique whereby two fiducials are implanted with each needle insertion under CT guidance.【Methods】From August 2011 to July 2012,429 patients of liver tumors accepted fiducial implantation with the technique of one insertion placing two fiducials,among whom the youngest was 19 years old and the oldest was 74.In total,1252 fiducials were implanted with this technique.Based on the technique of one insertion placing one fiducial,the new technique implanted 2 fiducials with one puncture.For the technique of one insertion placing two fiducials,an initial CT image of the tumor is used to determine the implanting depth and angle of the first fiducial marker.The first fiducial is placed using an 18-gauge needle,and the needle stylet and set remain stationary for 3 to 5 minutes after being slowly backed out 3-5 cm,and then the second fiducial is placed.Another image of fiducials is acquired to assess the distance between the fiducials,their angle with respect to each other,and their accordance with principles of fiducial placement before continuing the procedure.【Resluts】Among the 1252 fiducials implanted with the technique of one needle insertion placing two fiducials,18（1.44%） fiducials had a distance smaller than 20 mm between each other,24（1.92%） fiducials were collinear on the direction 45°,17（1.04%） fiducials migrated to other organs,and the qualified rate was 95.28%.With this technique,626 punctures are required while 1252 punctures are needed if adopting the technique of one needle insertion placing one fiducial.So the former technique doubles the fiducial implanting efficiency and halves the number of needle punctures.【Conclusion】The technique of one insertion placing two fiducials doubles the implanting efficiency and halves the puncture times so that the cost and risks are both reduced.The distance between fiducials smaller than 20 mm and the fiducials collinear on the direction of 45°are the crucial factors influencing qualified rate,and only by mastering these operation essentials can we assure that the fiducials are actually available.
出处
《中国医学工程》
2013年第1期1-3,6,共4页
China Medical Engineering
基金
军事医学计量科研专项课题(NO.2011-JL2-050)
