经皮肝穿刺植入可回收金标在射波刀追踪治疗的实验研究

Experimental study of percutaneous transhepatic implantation of recoverable fiducial marker in Cyberknife tracking therapy

目的评估一种肝脏金标植入新方法在兔肝脏内固定及取出的可行性,以期用于射波刀金标追踪治疗。方法分为活体实验和离体实验。活体实验对10只家兔麻醉后,经皮肝穿刺植入3颗金标,10 d后植入设有外置套管和固定细线的第4颗金标,以射波刀分别对参照组(第1颗和第2颗)和套管组(第1颗和第4颗)配准后追踪,施照结束后,评估金标植入成功率、配准精度及取出的安全性。离体实验在离体的肝脏进行金标拉力测试,测量弹簧圈金标和无弹簧圈金标取出时所受阻力。结果实验过程中金标没有出现远处转移的情况,植入与回收成功率均为100%。操作过程家兔未发生明显相关并发症和术后并发症。所有金标均成功追踪,套管组的配准平移偏差在头脚方向和前后方向高于参照组(Z=-11.77、-4.57,P<0.05),而左右方向低于参照组(Z=-2.52,P<0.05)。金标拉力测试结果显示弹簧圈金标拉力为(2.23±0.85)N,无弹簧圈金标拉力为(0.81±0.13)N,差异有统计学意义(Z=-2.31,P<0.05)。结论螺旋线圈结构金标在穿刺针道内的固定效果好,细线限制了金标肝外远处移位,套管为金标回收建立通道,整体操作简单易行。

Objective To evaluate the feasibility of a novel liver fiducial marker implantation method for internal fixation and removal of rabbit livers,in order to use in Cyberknife tracking therapy.Methods Experiments were conducted in vivo and in vitro.In the in vivo experiment,three fiducial markers were implanted percutaneously in each liver of ten rabbits under anesthesia,and the fourth fiducial marker with an external catheter and fixed thin wire was implanted ten days later.After the reference group(the first and the second maker),and the casing group(the first and the fourth marker)were respectively registered and tracked with the Cyberknife,the implantation success rate,registration accuracy,and removal safety of fiducial markers were assessed.The tensile test was performed using liver in vitro by measuring the resistance required to dislodge the spring coil fiducial markers and the fiducial markers without spring coil from liver.Results The intrahepatic catheter implantation and removal of fiducial marker in rabbit liver had a success rate of 100%and no distant migration.The operation-related and postoperative complications were not occurred.All fiducial markers were successfully traced.Compared to the reference group,the casing group had slightly higher translational errors in supero-inferior and antero-posterior directions(Z=-11.77,-4.57,P<0.05),and lower translational errors in left-right direction(Z=-2.52,P<0.05).The dislodgement forces for spring coil fiducial markers was(2.23±0.85)N,significantly different with(0.81±0.13)N for fiducial markers without spring coil(Z=-2.31,P<0.05).Conclusions The spiral coil structure provides superior fixation in the punctured needle channel,the thin line limits the distant displacement of the fiducial marker outside the liver,and the catheter establishes a channel for the removal.The general operation is simple and easy.