摘要目的 比较浅表转移癌3D打印模板引导125I粒子植入与传统植入的剂量学差异,研究3D打印模板对术前计划实施的准确性.方法 对2015年1月至2018年5月河北省人民医院行浅表转移癌粒子植入手术患者21例共27个病灶回顾性分析,3D打印模板引导粒子植入10例(模板组),传统方法粒子植入17例(传统组),应用计算机治疗计划系统(TPS)设计术前计划及术后验证计划,得出剂量体积直方图.比较各组术前术后90％靶体积接受的剂量(D90)差异有无统计学意义.利用公式D90d=D90术后-D90术前,D90d％=(D90术后-D90术前)/D90术前×100％,计算两组间D90的差值及差值百分比,观察两组间D90差值及差值百分比差异有无统计学意义.结果 模板组手术前后D90均数分别为(92±26)和(93±27)Gy,t=-0.749,P=0.473.传统组手术前后D90分别为(104±29)和(104±26)Gy,t=-0.139,P=0.891,差异均无统计学意义.模板组与传统组术前术后D90差值分别为(3.1±2.4)和(10.0±8.7)Gy,Z=-2.5,P=0.012,差值百分比为3.1％±1.9％和9.5％±7.9％,Z=-2.7,P=0.006,模板组较传统组术前术后剂量波动更小,差异有统计学意义(均P<0.05).结论 3D打印模板引导粒子植入术后剂量与术前计划剂量有较好的一致性,且重复性好,为3D打印技术的推广和普及提供理论依据.

abstractsObjective To compare the dose difference of 125I seeds implantation on superficial metastatic carcinoma between 3D print template guided operation and traditional implantation. To investigate the accuracy of seeds implantation according preplan guided by 3D print template. Methods A total of 21 cases of patient with 27 lesions underwent 125I seeds implantation from January 2015 to May 2018 in Hebei General Hospital were analyzed retrospectively. In which, ten lesions underwent seeds implantation guided by 3D print template (template group) and 17 lesions underwent free-hand traditional implantation (traditional group). All patients had been fixed as the position of operation and then performed CT scan. After preplan was designed, the 3D templates were printed in template group. Postplan was performed after the operation. The dose volume histogram, D90 was calculated. The D90 pre and post operation were collected and compared in each group. The difference of D90 and the percentage difference of D90 between pre and post operation were calculated by the formula D90d=D90post-D90pre, D90d％=(D90post-D90pre)/D90pre× 100％, and compared the difference between two groups. Results The mean D90 pre and post operation in template group were (92±26) and (93±27) Gy respectively, t=-0.749, P=0.473. The mean D90 pre and post operation in traditional group were (104 ± 29) and (104 ± 26) Gy respectively, t=-0.139, P=0.891. The difference of D90 in two groups were (3.1 ± 2.4) and (10.0 ± 8.7) Gy, Z=-2.5, P=0.012. The percentage difference of D90 in two groups were 3.1％±1.9％and 9.5％±7.9％, Compared with the traditional group, the template group had smaller fluctuations,and the difference was statistically significant (Z=-2.7,P=0.006)(all P<0.05). Conclusions The dose parameters of 3D template guided seeds implantation between postplan and preplan are nearly consistent. 3D template has good repeatability, which provides a theoretical basis for the popularization of 3D printing technology.