CAJ | 학술논문

目的：探讨食管超声下钛夹作为基准标记对食管癌病灶GTV确定的意义及钛夹标记的稳定性、安全性及不良反应。方法入组36例食管癌患者，放疗定位前行食管超声下钛夹标记，记录食管超声下T分期和内镜下临床分型。钛夹标记前后各采集CT定位图像一次，由同一名医生勾画钛夹标记前后采集CT图像的GTV，分别记录钛夹标记前后GTV体积，钛夹标记前后病灶上下缘最大差值的绝对值。结果①36例患者均完成试验，40个病灶，78枚钛夹被植入，CT观察到77枚（98．57％），钛夹脱落中位时间为23天，无Ⅲ度以上钛夹置入相关性不良反应。②钛夹基准标记后勾画GTV体积增大的有7例（19．44％），缩小的有23例（63．88％）。钛夹标记前后GTV体积参数差异有统计学意义（P＝0．038）。③内镜分型与超声T分期的病例分布经PERSON相关性检验显示有统计学意义（γ＝0．928，P＝0．000）。以上下界勾画误差绝对值大于1 cm为二分量计数标准，经多因素回归检验提示：内镜分型与勾画GTV上下边界误差有相关性（P＝0．041），超声T分期与勾画误差无相关性。结论结论食管超声下钛夹定位操作简单、安全、可靠性强，可改善食管癌放疗靶区的勾画，内镜下临床分型对临床靶区勾画有参考价值。
목적：탐토식관초성하태협작위기준표기대식관암병조GTV학정적의의급태협표기적은정성、안전성급불량반응。방법입조36례식관암환자，방료정위전행식관초성하태협표기，기록식관초성하T분기화내경하림상분형。태협표기전후각채집CT정위도상일차，유동일명의생구화태협표기전후채집CT도상적GTV，분별기록태협표기전후GTV체적，태협표기전후병조상하연최대차치적절대치。결과①36례환자균완성시험，40개병조，78매태협피식입，CT관찰도77매（98．57％），태협탈락중위시간위23천，무Ⅲ도이상태협치입상관성불량반응。②태협기준표기후구화GTV체적증대적유7례（19．44％），축소적유23례（63．88％）。태협표기전후GTV체적삼수차이유통계학의의（P＝0．038）。③내경분형여초성T분기적병례분포경PERSON상관성검험현시유통계학의의（γ＝0．928，P＝0．000）。이상하계구화오차절대치대우1 cm위이분량계수표준，경다인소회귀검험제시：내경분형여구화GTV상하변계오차유상관성（P＝0．041），초성T분기여구화오차무상관성。결론결론식관초성하태협정위조작간단、안전、가고성강，가개선식관암방료파구적구화，내경하림상분형대림상파구구화유삼고개치。
Objective To study the placement of endoscopic ultrasound-guided titanium clips in radiation treatment plan for esophageal cancer ,and its stability,safety and adverse reactions .Methods 36 patients with esophageal carcinoma received ti-tanium clips placement under EUS-guidance before the CT of simulation scanning .All patients’ information about the T-stage and the classification of endoscopic appearance were registered .All patients underwent CT-scan before and after the clips placement . Then the CT images of the 2 groups were transferred to the treatment planning system .The GTV ( gross target volume ) was out-lined by the identical oncologist .The volume of GTVs , the difference values of longitudinal GTV ’ s margin with being outlined twice before and after the clips placement were registered .Results ①36 patients had endoscopic clips placed ,a total of 78 fidu-cial clips was placed on the 40 tumors.77 clips were identified through CT images .The median time from clips placement to shed-ding was 23 days.More than grade Ⅲ toxicity have never be observed .②There were 7 cases(19.44%) of GTV having an in-crease and 23 cases (63.88%) of GTV having a decrease with the use of the fiducial clips .There was statistically significant difference (P<0.038).③The classification of endoscopic appearance was associated with T-stage by endoscopic ultrasonogra-phy.In multivariate logistic regression analysis ,the difference values of longitudinal GTV ’ s margin was significantly associated with the classification of endoscopic appearance ,but not associated with T-stage.Conclusion Endoscopic ultrasound-guided fi-ducial titanium clip placement for esophageal cancer aids predicatively in target delineation for radiation planning .The technique is expedient ,safe and stable .