导航引导和导航超声造影辅助消融超声显示困难肝癌  

Ablation of Hepatocellular Carcinoma Invisible in B-mode Ultrasound Using Navigation and Navigation Assisted Contrast-enhanced Ultrasound

作　　者：李凯[1] 曾庆劲[1] 郑荣琴[1] 苏中振[1] 邓美海[2] 姚志成[2] 

机构地区：[1]中山大学附属第三医院超声科∥超声诊断与介入超声研究所,广东广州510630 [2]中山大学附属第三医院肝胆外科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2012年第4期549-552,共4页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2010B031600215)

摘　　要：【目的】探讨导航引导及术中导航超声造影在消融二维超声显示困难肝癌的临床价值。【方法】对34例患者共42个CT/MR提示但二维超声显示困难的肝癌病灶,将超声与CT/MR图像融合后,在导航引导下行射频消融,并于术中使用导航超声造影即时评价消融效果。消融术后1个月行CT/MR评价消融是否完全。【结果】42个病灶的超声-CT/MR图像融合成功率100%(42/42),图像融合用时5～20 min,平均8.5 min。6个病灶(6/42,14.3%)按计划消融后导航超声造影提示消融范围不足,分别再次穿刺1～2针消融。术后1个月CT/MR提示42个病灶均消融完全。【结论】导航能引导消融二维超声显示困难的肝癌病灶,并可辅助超声造影术中即时评价消融效果,达到完全消融病灶的目的。[Objective] To evaluate the use of navigation and navigation assisted contrast-enhanced ultrasound （CEUS） in ablation of hepatocellular carcinoma （HCC） invisible in B-mode ultrasound. [Methods] Forty-two HCC lesions in 34 patients were enrolled, and all the lesions were diagnosed by CT/MR but invisible in B-mode ultrasound. Eight of the patients had elevated serum AFP. Under general anesthesia, after image fusion between the ultrasound and CT/MR, the navigation system could decide the location and boundary of the HCC in ultrasound image. Radiofrequency ablation （RFA） guided by navigation was applied. By fusing the CT/MR image before RFA with CEUS after RFA, navigation assisted CEUS was employed right after ablation to decide whether the area of ablative zone had covered the whole HCC. Additional puncture was applied if ablative zone had not completely covered the HCC. All the patients received CT/MR one month after ablation to decide whether the HCC had been completely ablated. [ Results] The image fusion was successfully applied in all 42 HCCs, and on average, 8.5 rain （5-20 rain） was spent in image fusion. Six HCCS （6/42, 14.3%） received extra 1 to 2 punctures after navigation assisted CEUS. Haemothorax was found in one patient one day after RFA. Catheter was applied for drainage and was removed after ultrasound revealed no fluid in the chest cavity 4 days later. Twelve patients had asymptomatie pleural effusion or ascites after ablation which disappeared in 1 to 2 weeks. One month after RFA, CT/MR showed that all the HCCs had been completely ablated, and the elevated serum AFP in the 8 patients all fell into normal range. [ Conclusions ] Navigation and navigation assisted CEUS could successfully ablate HCC invisible in B-mode ultrasound.

关 键 词：肝癌 导航 图像融合 导管消融术 

分 类 号：R735[医药卫生—肿瘤]