腹部压块对膈肌运动影响的研究

Study on Changing of Diaphragm Motion Effected by Abdomen Pressure

目的 :研究腹部压块对膈肌运动的影响。方法 :选择拟行立体适形放疗患有肺癌或肝脏肿瘤的患者 2 0例。按治疗体位仰卧于体部立体放疗定位负压袋内 ,待患者呼吸平稳后 ,将灯光野的中心点置于膈顶运动的最低点 ,在膈肌运动至最高位时拍摄照片 ,测量膈肌运动的最大幅度 ;然后 ,将心形腹部压块放置于患者剑突下 ,并用定位框架的腹带交叉固定 ,按压程度以不引起患者呼吸困难或其他不适为标准 ,5min后按上述方法再次测量膈肌运动的最大幅度。结果 :2 0例患者未加腹部压块的运动幅度为0 6 2～ 2 6 7cm ,平均 (1 4± 0 6 4)cm ,加腹部压块后的膈肌运动幅度为 0 2 8～ 2 0 8cm ,平均 (1 0±0 5 5 )cm ,加腹部压块后膈肌运动幅度平均减小 (0 4± 0 34)cm ,P =0 0 0 0。加腹部压块后 90 % (18/2 0 )的患者膈肌运动幅度受到不同程度的限制 ,但有 10 % (2 /2 0 )的患者膈肌运动幅度增加。结论 :腹部压块可使大部分患者膈肌运动的幅度减小 ,但少部分患者例外 ,即腹部压块并不能使所有膈肌周围肿瘤的照射容积减少。

Objective To study the effect of abdomen pressure on diaphragm motion.Methods 20 patients with lung or hepatic carcinomas,who were being treated with three dimensional conformal radiotherapy (3D CRT),were recruited.Patients were set up in their vacuum bags in the same supine position as in 3D CRT CT sim planning.Under free breathing conditions,the diaphragm moving ranges of patients were monitored using X ray simulator.While patients breathed steadily,the cross line of light beam of X ray simulator was placed at the lowest point of diaphragm top.As soon as the diaphragm top moved to its highest point,the picture was taken and the greatest moving amplitude was then got.Then a heart shape presser was placed just below the xiphisternum.The pressure was adjusted until patients felt comfortable.Five minutes later the greatest moving range of the diaphragm was again measured using the same method as above mentioned.Results The greatest diaphragm motions over all patients without abdomen pressure ranged from 0 62 cm to 2 67 cm with an average of 1 4cm±0 64 cm.For patients with abdomen pressure,the greatest diaphragm motion ranged from 0 28 cm to 2 08 cm with an average of 1 0 cm±0 55 cm.The diaphragm motion amplitude of patients with abdomen pressure was significantly reduced by an average of 0 4 cm±0 34 cm ( P =0 000).The diaphragm motion was limited by abdomen pressure in 90% of patients,while in another 10% of patients the diaphragm motion increased.Conclusions Abdomen pressure can lessen diaphragm motion amplitude of most patients except a few ones.In another word,abdomen pressure can not make all of the radiation target volumes around diaphragm smaller.We suggest whether the abdomen pressure is needed should be evaluated individually before optimizing radiation therapy planning.