目的: 探索个体化尿量控制训练模式,以个体化预期尿量为患者膀胱管控的目标,指导泌尿系统肿瘤患者主动感知膀胱容受性,提高放疗期间膀胱管控的精准度。方法: 选择2019年5月—9月北京大学第三医院收治的25例泌尿系统肿瘤患者。放疗定位前进行憋尿训练,要求患者以个体化膀胱适度充盈为训练目的,建议最佳的膀胱容量范围200~400 mL。训练2~4周后根据患者个体化的膀胱容受性确定放疗定位条件和放疗实施时的膀胱处方体积。患者CT模拟定位时采集平扫CT图像和静脉注射造影剂后8 min图像,分别测量膀胱体积。患者治疗前自评膀胱体积接近膀胱处方体积时使用膀胱容量测量仪测量体积,治疗前行锥形束计算机断层扫描(cone beam computed tomography,CBCT)并测量膀胱体积,治疗结束后再次使用膀胱仪测量膀胱体积。结果: 放疗前自评膀胱体积(V_EVA01)与放疗前膀胱仪测量体积(V_BVI01)、定位CT测量膀胱体积(V_CT01)与放疗前膀胱仪测量体积(V_BVI01)、定位CT测量膀胱体积(V_CT01)与CBCT测量膀胱体积(V_CBCT)存在相关性,配对样本t检验差异无统计学意义。定位CT体积(V_CT01)与放疗前自评膀胱体积(V_EVA01)、放疗前自评膀胱体积(V_EVA01)与CBCT体积(V_CBCT)存在相关性,配对t检验差异无统计学意义。结论: 前列腺癌和膀胱癌等泌尿系统肿瘤放疗期间,在膀胱容量测量仪的辅助下尝试让患者根据自身情况适度憋尿,个体化膀胱处方可能有利于实现放疗期间稳定的膀胱体积。

Objective: To explore the training mode of individual urine volume control, to take indi-vidual expected urine volume as the goal of bladder control in patients with urinary system tumors, and to improve the accuracy of bladder control during radiotherapy by active training of bladder receptivity. Methods: Twenty-five patients of urinary system tumors were enrolled from May 2019 to September 2019, of whom, 21 patients had prostate cancer, and 4 had bladder cancer. Training of bladder filling started before CT simulation. The patients were required to take the individual bladder filling as the training goal, and the optimal bladder volume range was suggested to be 200-400 mL. After 2-4 weeks of training, the prescribed volume of the bladder was determined according to the patient’s bladder receptivity. The volume of the bladder was measured by images of plain CT and images 8-minutes after intravenous contrast injection. The patient’s bladder volume was measured using BladderScan before treatment. CBCT (Cone-beam CT) was performed, and bladder volume was measured before treatment. The bladder volume was measured again using BladderScan after treatment. Results: The mean bladder volume of simulation (V_CT01) was (262±130) mL, ranging from 78 mL to 505 mL. The mean self-evaluation bladder volume before radiotherapy (V_EVA01) was (238±107) mL, ranging from 100 mL to 400 mL. The mean BladderScan measured volume before radiotherapy (V_BVI01) was (253±123) mL, ranging from 60 mL to 476 mL. The mean cone-beam CT measured volume before radiotherapy (V_CBCT) was (270±120) mL, ranging from 104 mL to 513 mL. There was a correlation between V_EVA01 and V_BVI01, V_CT01 and V_BVI01, V_CT01, and V_BVI01, and there was no significant difference in paired t-test. There was a correlation between differences of self-evaluation bladder volume before radiotherapy(V_EVA01) and simulation CT (V_CT01) and differences of self-evaluation bladder volume before radiotherapy (V_EVA01) and cone-beam CT (V_CBCT), and there was no significant difference in paired samples by t-test. Conclusion: During radiotherapy for urinary system tumors, such as prostate cancer and bladder cancer, with the assistance of BladderScan, the patients could try to hold their urine moderately according to their conditions, and individualized bladder prescription may be beneficial to achieve stable bladder volume during radiotherapy.