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目的比较膀胱充盈和排空状态下,宫颈癌术后调强放疗靶区、危及器官的体积改变及照射剂量变化。方法宫颈癌根治性全子宫切除术及盆腔淋巴结清扫术后有盆腔放疗指征患者15例,分别于膀胱充盈状态和排空状态行CT检查,勾画放疗靶区和危及器官轮廓行调强放疗计划设计,比较膀胱充盈状态和排空状态下临床靶体积(clinical targetvolume,CTV)、计划靶体积(planning target volume,PTV)及直肠、膀胱、股骨头、小肠体积与照射剂量。结果膀胱充盈及排空时体积分别为(261±56)、(72±7)mL,差异有统计学意义(P=0.000);膀胱充盈及排空时CTV、PTV及直肠、股骨头和盆腔小肠体积比较差异无统计学意义(P>0.05);同一患者俯卧位调强计划下,膀胱处于充盈状态时膀胱、小肠、直肠受照射体积百分比较膀胱排空时低(P<0.05),膀胱和小肠的受照射剂量降低(P<0.05),CTV、PTV及直肠、股骨头的剂量比较差异无统计学意义(P>0.05)。结论宫颈癌术后膀胱充盈状态下行CT定位,在调强放疗过程中可减少膀胱、盆腔小肠照射剂量,对膀胱、盆腔小肠起一定保护作用。
Objective To compare the volume change of target organs, the volume of radiation-harmed organs and the change of irradiation doses under the state of bladder filling and emptying. Methods Fifteen patients with pelvic radiotherapy indications after radical hysterectomy and pelvic lymphadenectomy were performed CT scan in the state of filling and emptying of the cervix to outline the radiotherapy target area and the plan of strengthening the radiotherapy to endanger the contour of the organ The clinical target volume (CTV), planning target volume (PTV) and the rectum, bladder, femoral head, small intestine volume and irradiation dose were compared between the state of bladder filling and emptying state. Results The volumes of bladder filling and emptying were (261 ± 56) and (72 ± 7) mL, respectively, with statistical significance (P = 0.000). CTV, PTV and rectum, femoral head and pelvic There was no significant difference in the volume of small intestine between the two groups (P> 0.05). Under the condition of prone position adjustment in the same patient, the volume of bladder, small intestine and rectum irradiated by bladder was lower than bladder emptying (P <0.05) (P <0.05). There was no significant difference in dose of CTV, PTV, rectum and femoral head between the two groups (P> 0.05). Conclusions The postoperative bladder filling status of cervical cancer can be computed by CT and the dose of bladder and pelvic small intestine can be reduced in the process of IMRT, which may play a protective role in the bladder and pelvic small intestine.