一例3D打印组织间插植后装治疗复发宫颈癌患者的护理

Nursing report of one case of recurrent cervical cancer patient treated by after-loading therapy with interstitial brachytherapy assisted by 3D printing source device

目的 总结全国首例3D打印施源器导板辅助组织间插植治疗放疗后复发宫颈癌患者的护理经验.方法 对1例放疗后复发的宫颈患者行3D打印模版引导宫颈复发病变插植治疗,治疗前行CT扫描定位、术前计划设计、3D打印模版设计,治疗中按模板引导结合影像验证进行插植,剂量D904 Gy/f,每周2次,共5次.对患者进行心理及医疗方面的护理,总结护理要点,评估护理作用.结果 护理参与治疗前后的各个环节,包括心理护理、饮食指导、物品准备、患者评估、患者准备、插植中护理、放疗中护理、放疗后及并发症护理等.3D打印模板的引导可使插植针的分布更加合理、准确,配合完善的护理,可更好地降低操作及放射并发症的发生风险.结论 3D打印施源器引导组织间插植具有个体化、精确、重复性好等优点,认真、全面地做好治疗前、中、后护理,对进一步提高治疗效果、降低患者损伤风险、提高操作效率有至关重要的作用.

Objective To summarize the nursing experience of the first case of recurrent cervical cancer patient treated by after-loading therapy with interstitial brachytherapy assisted by 3D printing device in China.Methods For a patient with recurrent cervical cancer after radiotherapy,preoperative CT scan was carried out,preoperative plan was designed,3D printing template was designed,and brachytherapy was carried out according to the guidance of 3D printing source device and CT image verification. The treatment dose（D90） was four Gy/fraction,two fractions per week and five fractions in all. The patient was given psychological and medical nursing. Key points of nursing were summarized and role of nursing was evaluated.Results Nursing work was involved in the entire process of treatment,including psychological nursing,diet guidance,instruments preparation,patient assessment and preparation,nursing during brachytherapy,nursing during and after radiotherapy,and nursing for complications,etc. Operation risks and radiation complications could be effectively reduced by comprehensive nursing,together with more reasonable and accurate distribution of implant needles guided by 3D printing source device.Conclusions The advantages of interstitial brachytherapy assisted by 3D printing source device include individuality,accuracy,and good repeatability. A serious and comprehensive nursing work before,during and after the treatment plays an essential role in improving therapeutic effect, reducing patients′ risk of injury and improving operational efficiency.