实时虚拟导航系统在结直肠癌肝转移射频消融治疗中的应用  

Ultrasound guided ablation therapy of hepatic colorectal metastases: initial experience of real time virtual sonography navigation system

作　　者：原春辉[1] 修典荣[1] 葛辉玉[2] 谭石[2] 王行雁[1] 张利[1] 张同琳[1] 

机构地区：[1]北京大学第三医院普通外科,北京100191 [2]北京大学第三医院超声诊断科,北京100191

出　　处：《北京大学学报（医学版）》2013年第6期956-959,共4页Journal of Peking University:Health Sciences

基　　金：北京大学第三医院临床重点项目(64482-04)资助~~

摘　　要：目的：探讨实时虚拟导航系统在结直肠癌肝转移肿瘤射频消融（radiofrequency ablation，RFA）中的应用价值。方法：对12例患者共17个CT/MRI提示但二维超声显示不清晰的结直肠癌肝转移灶，利用实时虚拟导航系统制定术前穿刺消融计划。12例患者中，男性9例，女性3例，年龄45~82岁，平均（64.6±19.2）岁。将超声与CT/MRI图像融合后，术中根据术前计划在导航引导下对病灶及周边5 mm的消融安全边界进行RFA治疗，并于术中使用导航辅助的超声造影（contrastenhanced ultrasound，CEUS）即时评价消融效果，消融术后1个月行CT/MRI评价消融是否完全。结果：17个病灶的超声与CT/MRI图像融合成功率100％（17/17），图像融合用时8~21 min，平均12 min。1个病灶（1/17）按计划消融后导航系统辅助的CEUS提示消融范围不足，再次穿刺1针消融。本组12例患者未发生消融相关死亡及严重并发症。术后1个月，12例患者增强CT或MRI检查提示17个病灶均完全消融，完全消融率100％（17/17）。结论：实时虚拟导航系统对于常规超声无法显示的结直肠癌肝转移灶具有较高的定位检出率，并可辅助CEUS在术中及时评价消融效果。实时虚拟导航系统在对结直肠癌肝转移患者行RFA治疗时安全可行，能准确地引导病灶穿刺，取得良好的临床治疗效果。To evaluate the feasibility, accuracy and efficacy of the real time virtual sonography navigation and planning system in radio frequency ablation （RFA） of hepatic colorectal metastases. Methods： Seventeen hepatic colorectal metastases lesions in 12 patients diagnosed pathologically or clinically in Peking University Third Hospital from Oct. 2011 to Apr. 2013 were enrolled, and all the lesions were diagnosed by CT/MRI but invisible in B-mode ultrasound. The patients included 9 males and 3 females, who were 45-82 years old, with an average age of （64.6±19.2） years. Before RFA, the puncture ablation plan of each lesion was made in the planning system, and during RFA the lesion and the 5 mm ablative margin around were ablated according to the puncture ablation plan. After the image fusion between the ultrasound and CT/MRI, the navigation system could decide the location and boundary of the hepatic colorectal metastases in the ultrasound image. Navigation assisted contrast-enhanced ultrasound （CEUS） was employed right after ablation to decide whether the area of the ablative zone had covered the whole tumor. Additional puncture was applied if the ablative zone had not completely covered the tumor. All the patients received CT/MRI one month after ablation to decide whether the carcinoma had been completely ablated. Results： The image fusion was successfully applied in all the 17 hepatic colorectal metastases, and on average, 12 min （8-21 min） was spent in the image fusion. One tumor （1/17, 14.3%） received extra one puncture after navigation assisted CEUS. No severe complications and death occurred in all the 12 patients. Complete ablation of the 17 lesions were observed through CT or MRI scan one month after RFA, showing that all the 17 lesions had been completely ablated. Conclusion： The real time virtual sonography navigation system had high detection rate for invisible focal liver lesions in B-mode ultrasound. Navigation assisted CEUS could decide whether the area of the ablative zone had

关 键 词：结直肠肿瘤 肿瘤转移 导管消融术 肝肿瘤 实时虚拟导航系统 

分 类 号：R735.7[医药卫生—肿瘤]