CAJ | 학술논문

目的采用4DCT技术研究胃癌术后辅助放疗中吻合口的分次内和分次间动度.方法前瞻性纳入8例经毕Ⅰ式吻合胃癌根治术后行辅助放疗的局部晚期胃癌患者.在平静呼吸状态和控制残胃充盈条件下,进行疗前、疗中共4次4DCT扫描.以术后置入吻合钉为观察对象,评价吻合口在左右、前后、上下方向上分次内和分次间动度,并分析残胃体积变化与分次间动度的关系.组内差异行配对t检验,组间差异行单因素方差分析.结果吻合口分次内动度在左右、前后、上下方向上分别为(2.4±2.3)、(2.1±2.0)、(5.6±4.0) mm,上下方向上的显著大于左右、前后方向(P=0.000、0.000).分次间动度在左右、前后、上下方向上分别为(6.1±6.6)、(3.3±3.0)、(4.8±4.3)mm,分次间动度各方向间相近(左右:前后,P=0.064;左右:上下,P=0.156;前后:上下,P=0.161).在左右方向上分次间动度显著大于分次内动度(P=0.018).左右、前后、上下方向内边界分别为24.2、10.3、18.3 mm.结论经毕Ⅰ式胃癌根治术后辅助放疗时应考虑到分次内和分次间动度,吻合口合理内边界在左右、前后和上下方向上可分别外放24.2、10.3、18.3 mm.
목적 채용4DCT기술연구위암술후보조방료중문합구적분차내화분차간동도.방법 전첨성납입8례경필Ⅰ식문합위암근치술후행보조방료적국부만기위암환자.재평정호흡상태화공제잔위충영조건하,진행료전、료중공4차4DCT소묘.이술후치입문합정위관찰대상,평개문합구재좌우、전후、상하방향상분차내화분차간동도,병분석잔위체적변화여분차간동도적관계.조내차이행배대t검험,조간차이행단인소방차분석.결과 문합구분차내동도재좌우、전후、상하방향상분별위(2.4±2.3)、(2.1±2.0)、(5.6±4.0) mm,상하방향상적현저대우좌우、전후방향(P=0.000、0.000).분차간동도재좌우、전후、상하방향상분별위(6.1±6.6)、(3.3±3.0)、(4.8±4.3)mm,분차간동도각방향간상근(좌우:전후,P=0.064;좌우:상하,P=0.156;전후:상하,P=0.161).재좌우방향상분차간동도현저대우분차내동도(P=0.018).좌우、전후、상하방향내변계분별위24.2、10.3、18.3 mm.결론 경필Ⅰ식위암근치술후보조방료시응고필도분차내화분차간동도,문합구합리내변계재좌우、전후화상하방향상가분별외방24.2、10.3、18.3 mm.
Objective To study the intrafractional and interfractional anastomosis motion during postoperative adjuvant radiotherapy in gastric cancer by four-dimensional CT (4DCT).Methods Eight patients with locally advanced gastric cancer who underwent Billroth Ⅰ gastrectomy and postoperative radiotherapy were enrolled in this study and prospective analysis was performed.A total of four 4DCT,including simulation and repeating during radiation,were performed during free breathing and dietary restriction.The implanted anastomotic nail was used as the observational subject,and the intrafractional and interfractional anastomosis motion was evaluated in the right-left (RL),anterior-posterior (AP),and superior-inferior (SI) directions.The relationship between the volume change in remnant stomach and interfractional anastomosis motion was analyzed.The differences within and between groups were analyzed by paired t test and one-way ANOVA,respectively.Results The intrafractional anastomosis motion was (2.4 ± 2.3) mm,(2.1 ± 2.0) mm,and (5.6 ± 4.0) mm in RL,AP,and SI directions,respectively,and the motion in SI direction was significantly greater than that in RL and AP directions (P =0.000 and 0.000).The interfractional anastomosis motion was (6.1 ±6.6) mm,(3.3 ±3.0) mm,and (4.8 ±4.3)mm in RL,AP,and SI directions,respectively,with no significant differences between different directions (P =0.064,0.156,0.161).In RL direction,the interfractional anastomosis motion was significantly greater than the intrafractional anastomosis motion (P =0.018).The internal margins accounting for respiration related displacement and interfractional variability were 24.2 mm,10.3 mm,and 18.3 mm in RL,AP and SI directions,respectively.Conclusions The intrafractional and interfractional anastomosis motion should be considered during postoperative adjuvant radiotherapy in gastric cancer patients who have undergone Billroth I gastrectomy.The internal margins required for anastomosis in RL,AP and SI directions are 24.2mm,10.3 mm and 18.3 mm,respectively.