CAJ | 학술논문

目的：观察伽马刀立体定向放疗肝癌致肝组织辐射损伤的发生情况,分析相关因素。方法选择解放军123医院肿瘤科2011年8月-2013年8月收治的、经病理学证实的46例肝癌,分为乙肝病毒标志物( HBVM)(+)和HBVM(-)两组,每组23例,两组均行伽马刀立体定向放疗。于治疗前、治疗结束及治疗后4、15和25周评估两组Child-Pugh分级,检测白蛋白( ALB)、直接胆红素( DBIL)、丙氨酸转氨酶( ALT)、天冬氨酸转氨酶( AST)、碱性磷酸酶(AKP)。治疗前分别由CT诊断医师、临床医师勾画肿瘤靶区(GTV),比较两组GTV勾画差异(ΔGTV1)。比较两组治疗后15周与治疗前ALT变化幅度(ΔALT)及GTV变化幅度(ΔGTV2)。结果治疗后15周两组Child-Pugh分级、肝功能指标与本组治疗前比较差异均有统计学意义(P<0．05),HBVM(+)组上述指标与HBVM(-)组比较差异均有统计学意义(P<0．05),其余时间两组间及与本组治疗前比较差异均无统计学意义(P>0．05)；两组ΔALT、ΔGTV1差异有统计学意义(P<0．05),ΔGTV2差异无统计学意义(P>0．05)。结论应用伽马刀立体定向技术治疗肝癌时应充分考虑到患者的HBV感染状态,精确勾画、合理外放GTV范围,制订个体化的治疗计划,可减少肝损伤的发生。
목적：관찰가마도입체정향방료간암치간조직복사손상적발생정황,분석상관인소。방법선택해방군123의원종류과2011년8월-2013년8월수치적、경병이학증실적46례간암,분위을간병독표지물( HBVM)(+)화HBVM(-)량조,매조23례,량조균행가마도입체정향방료。우치료전、치료결속급치료후4、15화25주평고량조Child-Pugh분급,검측백단백( ALB)、직접담홍소( DBIL)、병안산전안매( ALT)、천동안산전안매( AST)、감성린산매(AKP)。치료전분별유CT진단의사、림상의사구화종류파구(GTV),비교량조GTV구화차이(ΔGTV1)。비교량조치료후15주여치료전ALT변화폭도(ΔALT)급GTV변화폭도(ΔGTV2)。결과치료후15주량조Child-Pugh분급、간공능지표여본조치료전비교차이균유통계학의의(P<0．05),HBVM(+)조상술지표여HBVM(-)조비교차이균유통계학의의(P<0．05),기여시간량조간급여본조치료전비교차이균무통계학의의(P>0．05)；량조ΔALT、ΔGTV1차이유통계학의의(P<0．05),ΔGTV2차이무통계학의의(P>0．05)。결론응용가마도입체정향기술치료간암시응충분고필도환자적HBV감염상태,정학구화、합리외방GTV범위,제정개체화적치료계화,가감소간손상적발생。
Objective To observe radiation injury and analyze related factors of patients with radioactivity liver injury induced by liver cancer after stereotactic radiotherapy with gamma knife. Methods A total of 46 patients with liv-er cancer confirmed by pathological examination during August 2011 and August 2013 were divided into the marker of hepatitis B virus (HBVM) ( +) group (n=23) and HBVM ( -) group (n=23), and the two groups were treated with stereotactic radiotherapy with gamma knife. Child-Pugh classification was evaluated in the two groups before treatment, after treatment and 4, 15 and 25 weeks after treatment. Levels of albumin (ALB), direct bilirubin (DBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (AKP) were detected. Before the treatment, gross tumor volume ( GTV) had been painted by CT physicians and clinicians respectively, and the differ-ences (ΔGTV1) of the two groups were compared. The differences in ALT variation (ΔALT ) and GTV variation (ΔGTV2) before treatment were compared with those 15 weeks after treatment. Results The differences in Child-Pugh classification and indexes of liver function in the two groups 15 weeks after treatment were statistically significant com-pared with those before treatment in the same group (P<0. 05), and the differences between the two groups also showed significant differences ( P<0. 05 ) , but the differences in the same group or between the two groups at the rest of the times were not statistically significant ( P>0. 05 ); there were statistically significant inΔALT and ΔGTV1 between the two groups ( P<0. 05 ) , but the difference showed no significant difference in ΔGTV2 ( P>0. 05 ) . Conclusion The stereotactic technique of gamma knife in treatment of liver cancer should take the infection status of HBV into account, so clinicians should accurately paint rationalely delineate range of external GTV and make individualized treatment plan to reduce the incidence rate of liver injury.