腹式呼吸训练在乳腺癌深吸气后屏气放疗中的应用

Application of abdomen breath training in deep inspiration breath hold radiotherapy for breast cancer

目的探讨腹式呼吸训练在乳腺癌深吸气后屏气放疗中的应用效果。方法根据深吸气后屏气(Deep Inspiration Breath Hold,DIBH)的技术特点和放疗临床要求,设计一种基于视频引导辅助的腹式DIBH(Video Assisted Abdomen DIBH,VAA-DIBH)呼吸训练方法。对2019年11月至2020年9月在苏州市立医院行放射治疗的乳腺癌患者,按入组条件随机分为常规组(16例)和VAA-DIBH组(14例)。统计两组患者年龄及自由呼吸(Free Breath,FB)下CT图像中双侧肺脏、心脏和切线内心脏V_(tan)的体积基值。再次定位CT扫描前两组分别采用常规和VAA-DIBH方法进行干预,比较在FB和DIBH下常规组和VAA-DIBH组各指标体积的在CT图像上的变化。采用t检验比较组间各体积指标均值差异。结果常规组与VAA-DIBH组共30例患者,两组平均年龄分别为(50.81±12.51)和(51.14±9.23)岁,差异无统计学意义(P>0.05)。在FB模式下左肺、右肺、心脏及心脏V_(tan)体积值,两组比较差异均无统计学意义(均P>0.05)。在DIBH模式下除右肺体积值常规组低于VAA-DIBH组,差异有统计学意义(P<0.05),其余各值比较差异无统计学意义(P>0.05)。进一步比较体积变化及变化百分比,除心脏外(P=0.959、0.782),常规组的左肺、右肺及心脏V_(tan)各值变化均小于VAA-DIBH组,差异均有统计学意义(均P<0.05)。结论VAA-DIBH呼吸训练方法可以有效减少乳腺癌患者心脏的预受照体积,提高患者DIBH幅度控制的稳定性。

Objective To investigate the effect of abdominal breathing training in breast cancer radiotherapy after deep inspiratory breath holding(DIBH).Methods According to the technical characteristics and clinical requirements of DIBH radiotherapy,a video assisted abdominal DIBH(VAA-DIBH)breathing training method is designed.Breast cancer patients who received radiotherapy in this hospital from November 2019 to September 2020 were randomly divided into conventional group(n=16)and VAA-DIBH group(n=14)according to the inclusion conditions.Age and V_(tan) volume base values of bilateral pulmonary hearts and hearts in tangent line in CT images under free breath(FB)of patients in the two groups were analyzed.Routine and VAA-DIBH methods were used to intervene in the two groups before repositioning CT scanning,respectively,and the changes of each index volume in the conventional group and VAA-DIBH group on CT images were compared under FB and DIBH.T test was used to compare the mean difference of each volume index between groups.Results There were 30 patients in the conventional group and VAA-DIBH group.The average age of the two groups was(50.81±12.51)and(51.14±9.23)years(P>0.05),and the difference was not statistically significant(P>0.05).In FB mode,the volume values of left lung,right lung,heart and heart's V_(tan) in the two groups was not statistically significant(P>0.05).In DIBH mode,except that the volume of right lung in routine group was lower than that in VAA-DIBH group,the difference was statistically significant(P<0.05),and there was no significant difference in other values(P>0.05).In the comparison of volume change and percentage change,except for the heart(P=0.959、0.782),value of the left lung,right lung and heart's V_(tan) the conventional group were less than those in the VAA-DIBH group and the difference was statistically significant(P<0.05).Conclusions VAA-DIBH breathing training method effectively reduces the exposure volume of the organs at risk in breast cancer patients,and improves the stability of patients undergoing DIBH.