電腦斷層定位用以肺小腫瘤有無雷射角度儀輔助之精準醫學研究一模型比較

研究目的：本研究旨在研究實施「電腦斷層定位用以肺小腫瘤有無雷射角度儀輔助之精準醫學研究一模型比較」。現今因根據全球地域性的不同，在不同的醫療中心有很多方法可以進行術前定位用以肺小結節的技術。在我們的中心，穿刺角度由經驗豐富的人於術前透過電腦斷層定位雷射角度儀引導組件 ® 技術來確定和引導穿刺角度。 儘管如此，術前電腦斷層定位有無使用雷射角度儀引導定位之輔助技術是否提供了精準醫療服務使得獲益包含：微創手術診斷治療精準性，病理結果準確性，術後生活質量提升，如肺功能保留、小傷口恢復快、疼痛減少、住院時間短、減少不必要的醫療費用支出等。而這項技術是否可提供新生代一個臨床技能訓練的橋樑，用以增進疾病照護技能的完整性，將在此研究設計目的中探討相互之間的影響相關性，以提供未來臨床更好的精準醫療優勢。研究方法及資料：本研究工具經由電腦斷層掃描，於以擬真胸腔規格特製設計之一胸腔體模具內含有似模擬胸腔體型、皮膚、肌肉、脊椎等，亦含有胸腔中雙側肺部以及肺部病灶，也伴隨有可識別方位的特製塗層製成。20號針規，89毫厘米脊椎穿刺針（Meditop，泰國）將應用於穿刺病灶，並且通過電腦斷層分析設計測量穿刺角度計劃，包括病灶大小、穿刺角度、穿刺角度之方向、從皮膚到病灶深度，和從肋膜到病灶深度，結合於有和沒有使用雷射角度儀引導輔助之下，每一次擊中病灶的完成度是否受穿刺頻率、穿刺時間、角度設計計畫等之間的相互影響性。另外，也評估此項技術是否受限於年齡、性別、經驗與否之操作依賴性。最後，也觀察此項技術之學習訓練計畫的潛在可朔性。本研究經資料蒐集完成之後，經鍵入、譯碼、核對，以統計性及互相影響之相關性之分析呈現，分析方法以SPSS for windows 18.0版套裝軟體，運用兩獨立樣本之無母數檢定「Mann-Whitney U檢定」、 「Wilcoxon Rank Sum檢定」樣本之分析; 並以「卡方檢定」、「迴歸分析」、「變異數分析」、及「成對樣本t檢定」運用於此變數中分析統計學上是否有顯著差。研究結果：經研究結果於有或無使用雷射角度儀輔助下，顯示在使用有雷射角度儀引導輔助之下，第一次穿刺頻率即可提供較高的命中率(86% v.s. 48%，P=0.000)，且有較大的穿刺角度計畫(27.98度 v.s.18.58度，P=0.003)，亦可提供穿刺病灶位於較困難或危險的體相中;於此技術下，也提供了免於第二次穿刺的需求度而造成的併發症等具顯著性的差異。穿刺角度方向選擇的設計將影響了穿刺頻率及穿刺時間具有一致的看法且具有顯著性的差異，(P=0.003，P=0.027)。穿刺定位病灶的命中率也受皮膚至病灶深度(P=0.000)、及肋膜至病灶深度的影響(P=0.000)等具顯著性的差異。此項技術則不受限於年齡、性別、經驗與否之操作依賴性。然而有趣的是，經驗值顯示了有顯著性差異於穿刺時間之影響(6.5分鐘 v.s 8.0分鐘，P=0.009)，另外，課前與課後的學習問卷分析也顯現了此項技術之學習曲線培訓計劃的潛在可朔性，(5.6分 v.s. 7.8分，P=0.004)。結論與建議：我們研究的局限性在於較短的學習曲線週期，以及模擬運用在真實人體環境下的危險區域。 然而，在組間使用電腦斷層有運用雷射角度儀引導定位輔助之下，提供了有效且潛在多項益處用於術前針對肺小腫瘤的治療計劃，並有精準醫療具有超乎想像的更大可能性，以促進臨床醫療時代的進步。該技術亦即為臨床實踐提供了一種新的、有效的培訓計劃。

Objective： This research aims to study the implementation of "Thecomparison of precision medicine research in a Phantom - ApplyComputed tomography-guided localization with or without Laser AngleGuided ® assembly for the small pulmonary nodules". Nowadays, thereare many ways to locate small pulmonary nodules before surgery indifferent medical centers due to the differences in global regions. In ourcenter, the puncture angle is determined and guided by an experiencedhand preoperatively through the computer tomography with laser angleguided assembly ® technology (LAGA). Nevertheless, whether theassistive technology of preoperative computer tomography localizationusing laser angle guided assembly provides precision medical services,benefits include the accuracy of minimally invasive surgery diagnosis andtreatment, the accuracy of pathological results, and the improvement ofpostoperative quality of life, such as pulmonary function preservation,quick recovery from small wounds, reduced pain, short hospital stay, andreduced unnecessary medical expenses. Furthermore, and whether thistechnology can provide a bridge for the new generation of clinical skillstraining to improve the integrity of disease care skills, we will explore themutual influence and correlation in the design of this research to providea way of better clinical accuracy in the future medical advantage.Methods and Materials： Under the computer tomography scan, thethoracic cavity phantom was specially designed to simulate the thoraciccavity body shape, skin, muscle, spine, and bilateral lungs and lunglesions in the thoracic cavity. It is made of a special coating that canidentify the position. A 20 gauge needle, 89-millimeter spinal punctureneedle (Meditop, Thailand) will be applied to puncture the lesion. Thepuncture angle plan will be measured through computer tomographyanalysis, including the size of the lesion, the puncture angle, the directionof the puncture angle, and the depth from the skin to the lesion, and fromthe pleura to the depth of the lesion, combined whether with or withoutthe aid of the laser angle guided assembly, to analyzed between each hitto the lesion affected by the interaction between the puncture frequency,puncture time, angle design plan, etc. In addition, it is also evaluatedwhether this technology is limited by age, gender, experienceddependence. Finally, observe this technology's learning curve trainingprogram. After the data collection, valid samples were processed andanalyzed by descriptive statistics, Mann-Whitney U test, Wilcoxon RankSum test, Paired samples t-test, and ANOVA by SPSS for windowsversion 18.0.Results： In our research, computer tomography localization with orwithout laser angle guided assembly technology, show that under theguidance of laser angle guided can provide a higher hit rate (86% vs48%), P=0.000), and with a larger puncture angle plan (27.98 degrees vs18.58 degrees, P=0.003). It demonstrates the way of providing a moredifficult puncture in the danger zone. This technique also provides asignificant difference in avoiding complications caused by the need for asecond puncture. The design of the puncture angle direction plan havesignificantly affected the puncture frequency and puncture time. There isa consistent view and significant difference (P=0.003, P=0.027). Thepuncture hit rate is also affected by the depth of the skin to the lesion(61.21mm, P=0.000), and the depth of the pleura to the lesion (45.11mm,P=0.000). This technology is not limited to age, gender, experienceddependence. However, what is interesting is that there is a significantdifference in the experienced hand in the impact of puncture time, (6.5minutes vs 8.0 minutes, P=0.009). In addition, the analysis of the studyquestionnaire before and after class also shows the greater potential of thelearning curve training program of this technology, (5.6 points vs 7.8points, P=0.004).Conclusion and Suggestion： The limitation of our research lies in theshort learning curve period, and simulate the dangerous area used in thereal human environment. However, computerized tomography with orwithout laser angle guided assembly technology in between groupsprovides effective and potentially multiple benefits for preoperativetreatment plans for small lung tumors, and precision medicine has agreater possibility to promote the advancement of the clinical medicalera. This technology also provides a new and efficacy training program inclinical practice.