术中超声在肝脏恶性肿瘤切除手术中的临床应用研究  

Clinical application of intraoperative ultrasonography in the resection of malignant liver tumor

作　　者：刘兵[1] 蒙轩[1] 袁静[2] 张爱群[1] 董家鸿[1] 

机构地区：[1]中国人民解放军总医院肝胆外科医院,全军肝胆外科研究所,北京100853 [2]中国人民解放军总医院病理科,北京100853

出　　处：《徐州医学院学报》2016年第2期107-110,共4页Acta Academiae Medicinae Xuzhou

基　　金：国家科技部支撑计划项目（2012BA106801）

摘　　要：目的探讨术中超声在肝脏恶性肿瘤切除术中的临床应用价值。方法选取术前行经腹超声及增强CT等检查，且术后病理证实为肝脏恶性肿瘤的患者48例，常规开腹后采用术中超声进行肿瘤定位并发现新的瘤病，统计术中超声对肝脏恶性肿瘤的检出率。比较术前经腹超声及增强CT与术中超声检查对肝脏恶性肿瘤诊断的敏感度和特异度。统计因术中超声检查结果而改变手术策略的病例。结果48例患者共发现69个病灶。其中肝细胞癌32例，胆管细胞癌11例，转移性肝癌5例。病理证实恶性肿瘤病灶56个，肿瘤大小平均3．65cm（0．5—7．5cm），其中有9个病灶直径≤1cm，18个直径为1—2cm，29个直径〉2cm。统计结果显示，术中超声鉴别肿瘤良、恶性的敏感度和特异度均比术前经腹超声高（P〈0．05），但和CT比较差异无统计学意义。对于直径〈1cm的肿瘤，术中超声的检出率明显高于术前CT和术前超声（P〈0．05）。因术中超声检查结果而改变术前手术决策患者13例（27．1％）。结论术中超声能够发现术前影像学检查未能发现的微小病灶，与术前增强CT相比具有较高的敏感度和特异度，并通过检查结果帮助术者调整手术策略，在肝脏外科具有很好的临床应用价值。Objective To evaluate the clinical application of intraoperative ultrasonography in the resection of ma- lignant liver tumor. Methods Forty - eight patients were selected in the current study. They underwent abdominal ultra- sound and enhanced CT examination before operation and were pathologically diagnosed with malignant liver tumor. Tumor localization and new tumor lesions were determined by intraoperative ultrasonography after conventional laparoto- my. The detection rate of malignant liver tumor by intraoperative ultrasonography was calculated. Meanwhile, preopera- tive transabdominal ultrasound, enhanced CT examination and intraoperative uhrasonography were compared for the sensi- tivity and specificity to diagnose malignant liver tumor. The cases where surgical strategies were adjusted due to intraoper- ative ultrasonography results were recorded. Results There were 69 loci in 48 patients, including 32 patients with hepa- toeellular carcinoma, 11 with bile duct cell carcinoma, and 5 with metastatic liver tumor. Fifty - six foei were proved pathologically malignant. The mean tumor size was 3.65 cm （0.5 - 7.5 em）. There were 9 foci with a diameter of 〈 1 cm, 18 foei with a diameter of 1 -2 cm, and 29 loci with a diameter of 〉 2 em. Intraoperative ultrasonography showed remarkably improved sensitivity and specificity for differentiating benign and malignant tumors, compared with preopera- tive abdominal uhrasonography （P 〈 0.05 ） rather than enhanced CT examination. For tumors with a diameter of 〈 1 em, the detection rate of intraoperative ultrasonography was significantly higher than that of preoperative CT and preoperative ultrasonography （P 〈 0.05 ）. There were 13 patients （27.1% ） whose surgical strategies were adjusted due to intraopera- tive ultrasonography results. Conclusion Intraoperative ultrasound is able to detect small foci that are otherwise unable to be found through preoperative imaging examination. Compared with preoperative enhanced CT, intraoperative ultra-sonograp

关 键 词：超声检查 术中超声 肝脏恶性肿瘤 肝切除术 

分 类 号：R608[医药卫生—外科学]