3D模板技术在老年晚期肺癌患者粒子植入中的临床应用

Clinical application of 3D template technology in particle implantation of elderly patients with advanced lung cancer

目的评估3D打印放射性粒子植入模板引导125I粒子植入治疗老年肺癌患者的临床疗效及并发症。方法回顾性分析2016年1月—2019年12月入住安徽医科大学第一附属医院老年呼吸与危重症学科治疗的80例老年晚期肺癌患者,其中采用自制3D打印非共面尼龙模板辅助粒子植入联合化疗的19例患者为模板组,徒手穿刺植入粒子联合化疗的21例患者为传统组,仅实施化疗的40例患者为化疗组,比较三组的局部控制率和有效率、剂量学参数、肿瘤标志物水平及并发症的发生情况。结果模板组的局部控制率和有效率、剂量学参数在术后显著优于传统组,植入后6个月和12个月模板组与传统组、化疗组的癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)水平差异有统计学意义(P<0.05),而三组的神经元特异性烯醇化酶(NSE)水平差异无统计学意义。模板组和传统组的手术并发症发生率差异无统计学意义,三组的化疗并发症发生率差异无统计学意义。结论自制3D打印非共面尼龙模板引导放射性粒子植入在老年肺癌患者局部控制效果较好,剂量分布满意,手术相关并发症较少,是一种临床疗效满意和适合作为老年肺癌患者的辅助治疗手段。

Objective To assess the clinical effect and complications of non-coplanar nylon templates guided radioactive 125I particles implantation, and these templates made by 3 D printer were applied to assist operation in the treatment of elderly lung cancer patients.Methods From January 2016 to December 2019, 80 elderly patients with advanced lung cancer admitted to our department were randomly divided into three groups.Nylon templates guided particle implantation was used in 19 cases as the template group.As traditional group(21 cases), particles were implanted by manual puncture.In these two groups, all patients were treated with chemotherapy after implantation.The third group, only underwent chemotherapy, was chemotherapy group(40 cases).Local control rate, effectiveness, dosimetric parameters, tumor marker levels and complications were compared among three groups.Results The local control rate, efficiency, and dosimetric parameters of the template group were significantly better than those of the traditional group after operation.The levels of carcinoembryonic antigen(CEA) and cytokeratin 19 fragments(CYFRA21-1) among the template group, the traditional group and chemotherapy group were statistically significant at 6 and 12 months after implantation, while the levels of Neuron Specific Enolase in the three groups were not statistically significant.The difference in the incidence of surgical complications between the template group and the traditional group was not statistically significant, and the difference in the incidence of chemotherapy complications among the three groups was not statistically significant.Conclusion The self-made 3 D printed non-coplanar nylon template guided radioactive particle implantation has good local control effect in elderly patients with lung cancer, satisfactory dose distribution, and few surgery-related complications.It is clinically satisfactory and suitable as an adjuvant treatment method for elderly lung cancer patients.