虚拟导航计划系统辅助肝细胞肝癌射频消融  

Ablation of hepatocellular carcinoma assisted by ultrasound-CT or MRI navigation and planning system

作　　者：李凯[1] 刘波[2] 曾庆劲[1] 苏中振[1] 邓美海[3] 郑荣琴[1] 

机构地区：[1]中山大学附属第三医院超声科中山大学超声诊断与介入超声研究所,广州510630 [2]中山大学附属第三医院岭南医院普外科 [3]中山大学附属第三医院肝胆外科

出　　处：《中华肝脏外科手术学电子杂志》2012年第2期25-29,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2010B031600215)

摘　　要：目的探讨虚拟导航计划系统辅助肝细胞肝癌（肝癌）射频消融（RFA）的可行性、准确性和治疗效果。方法该前瞻性研究选择2011年6至12月在中山大学附属第二医院收治，经病理或临床诊断为肝癌，并拟行RFA治疗的18例患者。所有患者均签署知情同意书，符合医学伦理学规定。男性17例，女性1例，年龄41-70岁，平均58岁。18例患者共有20个直径为10-20mml的肝癌病灶，利用虚拟导航计划系统制定术前穿刺消融计划，术中根据术前计划对病灶及周边5mm的消融安全边界进行RFA治疗。记录RFA术前制定消融计划所需时间、计划消融次数、实际消融次数、术中图像对位所用时间、图像融合成功率等指标；观察患者出血、腹水、胸腔积液等并发症和死亡发生情况；术后1个月行计算机断层摄影术（CT）或磁共振成像（MRI）检查及复查甲胎蛋白（AFP），了解完全消融率。采用两独立样本非参数检验比较实际消融次数与计划消融次数的差异。结果18例患者术前制定穿刺消融计划所需时间为13-22min，中位时间18min；计划消融次数2-4次，中位次数3次；术中冈像对位时间5-15min，中位时间8min，图像融合成功率100％（20／20）；实际消融次数2-4次，中位次数3次，与计划消融次数相比差异无统计学意义（Z=-0．311，P=0．820）。本组18例患者元发生消融相关死亡及严重并发症。术后1个月，18例患者均行增强CT或MRI检查提示20个病灶均完全消融，完全消融率100％（20／20）。结论虚拟导航计划系统辅助肝癌RFA治疗是安全可行的，能准确地引导病灶穿刺，取得良好的临床治疗效果。Objective To evaluate the feasibility, accuracy and efficacy of ultrasound-computed tomography （CT） or magnetic resonance imaging （MRI） navigation and planning system in radiofrequency ablation （RFA） of hepatoeellular carcinoma （HCC）. Methods In this prospective study, 18 patients with 20 HCC lesions diagnosed pathologically or clinically in the Third Affiliated Hospital of Sun Yat-sen University from June to December 2011, were enrolled. The diameter of these lesions was between 10-20 mm. All patients were planned to undergo RFA. Local ethical committee approval had been received and that the informed consent of all participating subjects was obtained. The patients included 17 males and 1 female and were 41-70 years old with an average age of 58 years old. Before RFA, puncture ablation plan of each lesion was made in planning system, and during RFA the lesion and the 5 mm ablative margin （AM） around were ablated according to the puncture ablation plan. Time spend in puncture planning, the plannedpuncture times, the actual puncture times, time spend in image fusion and image fusing success rate were recorded. Complications such as hemorrhage, aseites and pleural effusion, as well as patient death, were observed. All the patients received enhanced CT or MRI and alpha-fetoprotein （AFP） check-up 1 month after ablation to observe whether the HCC had been completely ablated. Results Time spend in puncture planning was 13-22 min （18 min mean time） and the planned puncture times were 2-4 with the mean of 3 times. The image fusion was successfully applied in all the 20 HCC patients, and an average of 5-15 rain （8 min mean time） was spent in image fusion. The actual puncture times were 2-4 with the mean of 3 times and no statistic difference was found between the planned and actual puncture times （Z=-0.311 ,P=0.820）. No severe complications and death occurred in all 18 patients. Complete ablation of 20 lesions were observed through CT or MRI scan one month after RFA showed that all the

关 键 词：肝细胞肝癌 虚拟导航计划系统 导管消融术 射频消融 计算机断层摄影术 磁共振成像 

分 类 号：R735.7[医药卫生—肿瘤]