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目的探讨肺癌放疗靶区勾画中主动呼吸控制(active breathing control,ABC)技术配合四维CT、简易腹部加压(simple manual epigastric compression,SMEC)技术配合四维CT对肺活动度、肺部放疗体积的影响。方法 50例非小细胞肺癌患者随机分为主动呼吸组27例,腹部加压组23例,主动呼吸组行ABC技术扫描和自由呼吸扫描,腹部加压组行SMEC技术和自由呼吸扫描,重建扫描图像后进行靶区勾画。比较ABC技术与自由呼吸扫描,SMEC技术和自由呼吸扫描模式下肺肿瘤左右(right-left,RL)、头脚(superior-inferior,SI)、前后(anterior-posterior,AP)运动幅度,依据剂量体积直方图评价两种技术双肺V_5、V_(10)、V_(20)、V_(30)剂量体积及总剂量体积(V_总)。结果主动呼吸组ABC扫描下肺肿瘤SI运动幅度[(5.04±0.64)mm]低于自由呼吸扫描[(15.58±0.71)mm](P<0.05),RL、AP运动幅度与自由呼吸扫描比较差异无统计学意义(P>0.05);腹部加压组SMEC技术扫描下肺SI运动幅度[(5.18±1.12)mm]低于自由呼吸扫描[(16.14±2.21)mm](P<0.05),RL、AP运动幅度与自由呼吸扫描比较差异无统计学意义(P>0.05);主动呼吸组ABC扫描下双肺V_5、V_(10)、V_(20)、V_(30)[(52.74±4.78)%、(38.76±4.92)%、(23.71±4.03)%、(15.54±3.43)%]均低于自由呼吸扫描[(62.54±5.63)%、(45.58±5.84)%、(29.02±5.10)%、(19.18±4.61)%](P<0.05),V_总[(3 725.00±184.41)cm3]高于自由呼吸扫描[(3 125.00±219.92)cm3](P<0.05);腹部加压组SMEC扫描下双肺V_5、V_(10)、V_(20)、V_(30)、V_总[(61.47±4.93)%、(43.89±4.74)%、(27.38±3.97)%、(17.77±3.56)%、(3 475.00±214.12)cm3]均低于自由呼吸扫描[(62.54±5.61)%、(45.58±5.40)%、(29.00±5.11)%、(19.18±4.62)%、(3 567.00±235.31)cm3](P<0.05);ABC扫描时SI、AP运动幅度与SMEC技术扫描比较差异无统计学意义(P>0.05),RL运动幅度低于SMEC技术扫描(P<0.05);ABC扫描时V_5、V_(10)、V_(20)、V_(30)低于SMEC技术扫描,V总高于SMEC技术扫描(P<0.05)。结论 ABC、SMEC技术配合四维CT均可有效减小肺肿瘤SI方向的呼吸动度,ABC技术在肺癌放疗靶区勾画中缩小V_5、V_(10)、V_(20)剂量体积及增加V总上效果明显。
Objective To investigate the effect of active breathing control (ABC) combined with four-dimensional CT and simple manual epigastric compression (SMEC) with four-dimensional computed tomography (CT) on lung activity and lung radiotherapy volume in lung cancer radiotherapy target area . Methods Fifty patients with non-small cell lung cancer were randomly divided into active breathing group (n = 27), abdominal compression group (n = 23), spontaneous breathing group (ABC technique) and free breathing scanning After the image of the target area outlined. Comparison of right-left (RL), superior-inferior (SI), anterior-posterior (AP) amplitude of motion with ABC and free-breathing, SMEC and free- Volume histograms were used to evaluate the volume and total dose volume of V_5, V_ (10), V_ (20) and V_ (30) Results Compared with free breathing scans [(15.58 ± 0.71) mm] (P <0.05), the amplitude of SI movement in the lung tumor was lower in the resuscitation group than that in the free lung scans (P <0.05) (5.18 ± 1.12) mm] was lower than that of the free breathing scans [(16.14 ± 2.21) mm] (P <0.05), while no significant difference was found between the two groups (P> 0.05). There was no significant difference in the amplitude of AP movement between the two groups (P> 0.05). The level of V_5, V_ (10), V_ (20), V_ (30) [52.74 ± 4.78] %, (38.76 ± 4.92)%, (23.71 ± 4.03)% and (15.54 ± 3.43)%, respectively, were lower than those of the free breath scan (62.54 ± 5.63), (45.58 ± 5.84)% and (29.02 ± 5.10)%, respectively , (19.18 ± 4.61)%] (P <0.05), V_ (3 725.00 ± 184.41) cm3] was higher than that of free breath scanning [(3 125.00 ± 219.92) cm3] The V_5, V_ (10), V_ (20), V_ (30), V_ (61.47 ± 4.93)%, (43.89 ± 4.74)%, (27.38 ± 3.97)% and (17.77 ± 3.56)%, (3475.00 ± 214.12) cm3] were significantly lower than those of the free breath scan [(62.54 ± 5.61)%, (45.58 ± 5.40)%, (29.00 ± 5.11)%, (19.18 ± 4.62)%, ± 235.31) cm3] (P <0. (P <0.05). There was no significant difference in the amplitude of movement of SI and AP between ABC and SCE compared with that of SMEC (P> 0.05) , V_ (20), V_ (30) were lower than that of SMEC technique and V was higher than that of SMEC technique (P <0.05). Conclusions Both ABC and SMEC combined with four-dimensional CT can effectively reduce the respiratory rate of SI in lung tumor. ABC technique can reduce the dose volume of V_5, V_ (10) and V_ (20) The effect is obvious.