評估以超音波合併螢光透視導引置放電腦刀定位金針於肝臟的安全性及金針區別率

Safety and Detection Rate of Combined Ultrasound and Fluoroscopy-Guided Fiducial Marker Implantation for Liver CyberKnife Radiation Therapy

鄭華銘(Hua-Ming Cheng)

指導教授 ： 鄭瑞棠

長榮大學/健康科學學院/醫學研究所/碩士(2015年)

https://doi.org/10.6833/CJCU.2015.00017

摘要

目的： 研究並探討影像導引之電腦刀定位金針的置放位置及方法，並比較電腦刀定位儀器上所能定位並區別出的金針數量，以做為日後
放置定位金針的參考。

方法：本研究收集於2008年12月起至2014年7月於南部某醫學中心影像醫學部接受電腦刀定位金針置放於肝臟之166位病患，調查病患置放金針後的併發症發生率，並經由與放射腫瘤科進行電腦刀計劃定位之金針偵測率做比較，從中找出相關性及電腦刀金針定位失敗的原因，以改進往後病患進行電腦刀治療定位的成功率。

結果：總共166位病患接受金針置放，有8位病患置放金針後即未再有進一步影像。有四位病患發生穿刺處出血，併發症發生率為2.5％。扣除部分病患術後拒絕定位治療及病歷無法尋回等等因素無法回溯金針定位結果者，共有129位病患完成治療、追蹤了516支金針，其中413支金針（80％）可於放射治療中被電腦刀儀器偵測到，沒有金針位移至肝臟以外。共111位病患（86％）治療時可以同時定位3支以上金針。將金針定位結果與腫瘤大小及所在肝臟位置做比較後並無發現特定關係會影響金針置放後的偵測率。

結論：此研究是目前查閱到文獻中針對肝臟腫瘤病患置入金針研究中病人數目最多者，在併發症、腫瘤定位功能面與其他研究相當，雖然無特定腫瘤因素會影響金針置放後的偵測率，但也證明超音波合併螢光透視機導引金針置放於肝臟為一可行之方式，可以降低金針位移率，可做為除了電腦斷層導引以外的選擇。

關鍵字

電腦刀 ； 定位金針 ； 肝腫瘤

並列摘要

Purpose: We want to know the possible complication rate and feasibility using guidance combined sonography and fluoroscopy to insert the fiducial marker into liver.

Materials and Methods: In this study, the patients were retrospective reviewed from December 2008 to July 2014 at a medical center in the southern portion of Taiwan who receiving fiducial markers implantation for liver tumor before CyberKnife positioning. Totally there were 166 patients. We investigate the complication type and rate for patients receiving fiducial markers implantation. The correlation between the fluoroscopy detection rate during CyberKnife® radiotherapy and the possible patient or technical factors were analysed.

Results: A total of 166 patients received implantation of fiducial marker in liver during this period of time. The complication rate was 2.5% and was associated with bleeding. Totally 129 patients completed the treatment of CyberKnife. There were 516 fiducial markers implanted (4 fiducials markers in every patient), of which 413 (80%) can be detected during the treatment. There were 111 patients (86%) that can be detected at least 3 fiducial markers. The migration rate was zero. There was no association about the detection of fiducial marker and location of tumor.

Conclusion: Fiducial implantation under sonography guidance combined with fluoroscopy appears to be a safe and efficient procedure that the complications and migration rate is acceptable.

並列關鍵字

cyberknife ； fiducial marker ； liver tumor

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