肝癌结节射频消融后残留癌的术中超声造影判定  

Intraoperative contrast-enhanced ultrasonography in the evaluation of the radiofrequency ablation completeness in patients with hepatic carcinoma of differently sized nodules

作　　者：高军喜[1] 高莹[1] 谷昊 许晓东 姚兰辉[1] 

机构地区：[1]新疆医科大学第一附属医院腹部超声诊断科,乌鲁木齐830011 [2]腔镜肝移植科 [3]介入放射科

出　　处：《中华普通外科杂志》2014年第1期25-28,共4页Chinese Journal of General Surgery

基　　金：新疆医科大学第一附属医院科研奖励基金资助项目（2010YFYl2）

摘　　要：目的探讨术中超声造影在大小不同肝癌结节射频消融治疗中残留判定的价值。方法对病理证实的55例（共69个病灶）肝癌患者进行射频消融治疗，分为实验组（采用术中超声造影）20例（共30个病灶）和对照组（未采用术中超声造影）35例（共39个病灶），治疗结束后定期采用增强CT判定疗效，并对肿瘤大小进行分层后分析2组患者的肿瘤残留率及24个月内的复发率，探讨术中超声造影在肝脏射频消融残留判定中价值。结果术后1个月实验组及对照组总体肿瘤残留率分别为13．3％及35．9％，2组的肿瘤残留率比较差异有统计学意义（X2=5．366，P〈0．05）。病灶直径〉5cm以及3—5cm者实验组残留率分别为30．0％，10．0％，对照组残留率分别为87．5％及46．2％，2组比较差异有统计学意义（分别X2=5．951，4．790，均P〈0．05）；术后24个月内实验组及对照组的总体复发率分别为13．3％及28．2％，2组比较差异无统计学意义（P=0．138）。病灶直径〉5cm者，实验组及对照组复发率分别为20．0％及75．0％，两者比较差异有统计学意义（P〈0．05）。结论术中超声造影对不同大小肝癌结节射频消融治疗的残留判定具有很好的价值，可降低大肿瘤消融治疗后的复发率。Objective To explore the value of intraoperative contrast-enhanced ultrasonography in radiofrequency ablation completeness evaluation in patients with hepatic carcinoma of differently sized nodules. Methods Fifty five patients （69 lesions） with hepatic carcinoma were included and were divided into the experimental group （20 cases, 30 lesions in whom CEUS were used ） and the control group （35 cases ,39 lesions, conventional ultrasound was used）. After RAF, the treatment effect of the two groups were evaluated by enhanced CT regularly. Differences between conventional ultrasound and CEUS were compared and their judgement on ablation residual tumor tissue was analyzed. Results After 1 to 24 months of follow-up, the total residual rate of the experimental group and the control group was 13.3% （4/30） and 35.9% （14/39） respectively. The significant difference was found in the residual rate between the experimental group and the control group （X2 = 5. 366, P 〈 O. 05）. For the two groups （ 〉 5 cm and 〈3 -5 cm） ,the residual rate of the experimental group was 30.0% and 10.0% , the residual rate of the control group was 87. 5670 and 46. 2%, there were statistically significant difference （ respectively X2 = 5.951,4. 790, all P 〈 O. 05 ）. The significant difference was found in the recurrence rate （ the experimental group： 20. 0% （4/30）, the experimental group： 75.0% （6/8） ）, when the lesion was larger than 5 cm in diameter（ X2 = 5. 445,P 〈 0. 05）. Conclusions CEUS has advantage over conventional ultrasound for the detection of residual tumor tissues after radiofrequency ablation for hepatic carcinoma, it reduces after ablation tumor recurrence especially in large tumors.

关 键 词：癌 肝细胞 超声检查 射频消融 

分 类 号：R735.7[医药卫生—肿瘤] R445.1[医药卫生—临床医学]