3D打印模板联合CT引导粒子植入治疗前列腺癌一例报告并文献复习

目的：探讨3D打印模板引导经臀部皮肤直肠两侧后入路行¹²⁵I粒子植入治疗前列腺癌的可行性和安全性。 方法：选取我科一例因直肠反应严重未能完成外放疗的老年前列腺癌患者，应用3D打印模板引导¹²⁵I粒子植入进行补量治疗。术前患者俯卧位真空垫固定，行盆腔CT强化扫描，术前计划满足剂量学要求后，将术前计划传入3D打印机打印模板。术中调整患者体位与术前定位一致，校正模板位置后臀部皮肤局部浸润麻醉，在CT引导下按照术前计划经臀部皮肤直肠两侧后入路穿刺前列腺并植入¹²⁵I粒子。 结果：在3D打印模板引导下，经臀部皮肤直肠两侧后入路可精准穿刺至术前计划位置，粒子植入位置与术前计划一致，靶区及危及器官剂量学参数与术前计划基本一致。术中未出现出血、直肠损伤、尿道损伤等并发症。术后2个月前列腺特异抗原（PSA）由术前的10.16 ng/ml降至6.93 ng/ml。CT复查评价为肿瘤稳定。 结论：局麻下3D打印模板引导经臀部皮肤直肠两侧后入路植入¹²⁵I粒子治疗前列腺癌安全可行，简便省时。

3D printed template and CT-guided brachytherapy for prostate cancer: A case report and review of literature

Objective:To investigate the feasibility and safety of 3D printed template and CT-guided trans-pararectal ¹²⁵I seed brachytherapy for prostate cancer. Methods:An old patient with prostate cancer in our hospital was enrolled. He was treated by radiotherapy but did not finish the whole course because of the complication of the rectum. 3D printed template guided brachytherapy was used for a dose boost. An enhanced CT was performed after the patient was fixed in a prone position by a vacuum pad. The 3D printed template was made after the dose parameter in pre-plan was satisfied. During the procedure, the template was fixed on the surface of the patient's hip when the patient was fixed by the vacuum pad in the same prone position as before. The needles were inserted into the prostate through the skin and both sides of the rectum after local anesthesia. ¹²⁵I seeds were implanted into prostate according to pre-plan when CT showed all the needles were in the right place. Results:All the needles can be inserted into the right location according to pre-plan under the guidance of 3D printed template. The seeds location and dose parameter post-implant were the same with that in pre-plan. Complications such as hemorrhage, injury of the urethra and rectum were not found. The PSA reduced from preoperative 10.16 ng/ml to 6.93 ng/ml 2 month after the procedure and the tumor was stable disease evaluated by CT scan. Conclusions:Trans-pararectal ¹²⁵I seeds implantation guided by 3D printed template and CT under local anesthesia was a safe and time-saving way for prostate cancer.