祖国红,孙美丽,张 健,苏 晨,汪延明

目的：针对NSCLC SBRT患者采用腹部加压联合4D-CT呼吸管理技术，从而对其治疗精度的影响进行观察分析。方法：采用2021年10月以来我科收入NSCLC SBRT病例，随机选择15例，分为二组，4D-AC组采用腹部加压扫描4D-CT图像，4D-FB组扫描4D-CT图像，在10个呼吸时相CT图像融合而成的最大密度投影（maximum intensity projection,MIP）图像上勾画内肿瘤区（internal gross target volume,IGTV）,IGTV外放5mm为计划靶区（planning target volum,PTV）,勾画危机器官，设计计划，执行各自SBRT计划，每次给5、6、8GY,分6-10次，在2周左右完成，每次治疗前做CBCT扫描1次，4D-AC组给予腹部加压干预，4D-FB组按常规流程进行，不增加任何干预。对二组CBCT扫描的误差值进行记录统计分析。结果：⑴4D-RA较4D-FB组在Y、Z方向误差均有显著差异（p＜0.05），X⽅向无统计学意义。⑵4D-AC组CTV-PTV外扩边界需3mm。4D-FB组其外扩边界需4mm。结论：4D-AC组通过腹压管理干预呼吸较自由呼吸模式下的4D-FB组，治疗中能有效减小靶区变化及摆位误差，并且CBCT能及时校准误差，并且降低了对CTV-PTV的MPTV边界外扩值。

腹部加压联合4D-CT；NSCLC；SBRT；误差分析；靶区外扩分析

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