融合成像在原发性肝癌热消融术中即时疗效评价中的应用  

Application of fusion imaging in intraoperative instant curative effect evaluation of thermal ablation for primary liver cancer

作　　者：张曼[1] 李凯[1] 苏中振[1] 曾庆劲[1] 李柳军[1] 陈嘉欣[1] 吕淑敏[1] 许尔蛟[1] 郑荣琴[1] 

机构地区：[1]中山大学附属第三医院超声科,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2016年第2期105-109,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金重点项目(81430038);国家自然科学基金(81401434;81301931;81271669);广东省科技计划项目(2014A020212136);广东省产学研项目(2013B090200020);广东省医学科研基金(B2013137)

摘　　要：目的 探讨融合成像在原发性肝癌（肝癌）热消融治疗术中即时疗效评价中的应用价值.方法 本前瞻性研究对象为2014 年12 月至2015 年3 月在中山大学附属第三医院接受超声引导下肝癌热消融治疗的46 例肝癌患者,共计71 个病灶.其中男42 例,女4 例;年龄36～82 岁,中位年龄54 岁.所有患者均签署知情同意书,符合医学伦理学规定.所有肝癌病灶完成热消融后优先采用超声造影-CT/MRI 融合成像技术进行疗效评价,当无法完成时则采用单纯超声造影评价.根据评价方法分为融合成像组和超声造影组.观察指标包括两组病灶的大小、补充消融率、完全消融率.两组病灶直径的比较采用Z 检验,率的比较采用χ2 检验或Fisher 确切概率法.结果 本研究中25 例患者共31 个病灶采用融合成像即时疗效评价,26 例患者共40 个病灶采用单纯超声造影评价.以病灶直径≥ 20 mm 作为界值,融合成像组占58%（18/31）,明显高于超声造影组的30%（ 12/40）（χ2=5.638,P〈0.05）.融合成像组的补充消融率为52%（16/31）,明显高于超声造影组的22%（9/40）（χ^2=6.489,P〈0.05）.融合成像组的完全消融率为100%（31/31）,超声造影组为95%（38/40）,差异无统计学意义（P=0.501）.结论 融合成像与单纯超声造影均为术中即时疗效评价的重要方法,融合成像对于较大病灶能够更精准地进行即时疗效评价,有助于提高完全消融率.Objective To evaluate the application value of fusion imaging in intraoperative instant curative effect evaluation of thermal ablation for primary liver cancer (liver cancer). Methods Forty-six patients with liver cancer (71 lesions in total) undergoing ultrasound-guided thermal ablation in the Third Afifliated Hospital of Sun Yat-sen University between December 2014 and March 2015 were recruited in this prospective study. Forty-two patients were males and 4 were females, aged between 36 and 82 years with a median age of 54 years. The informed consents of all patients were obtained and the local ethical committee approval was received. After thermal ablation, clinical efficacy was preferentially assessed by contrast-enhanced ultrasound (CEUS)-computed tomography (CT)/magnetic resonance imaging (MRI) fusion imaging technique for all liver cancer lesions. If the fusion imaging was not successfully performed, simple CEUS was utilized for evaluation. According to the evaluation methods, the patients were divided into the fusion imaging group and CEUS group. The lesion size, supplementary and complete ablation rates in two groups were observed. The lesion diameter between two groups was compared using Z test and the ratio was compared using Chi-square test or Fisher's exact probability test. Results Fusion imaging was utilized for instant curative effect evaluation in 25 patients with 31 lesions, and simple CEUS was used for evaluation in 26 cases with 40 lesions. In the fusion imaging group, 58%(18/31) of the lesions were≥20 mm in diameter, signiifcantly higher compared with 30%(12/40) in the CEUS group (χ2=5.638, P<0.05). The supplementary ablation rate in the fusion imaging group was 52%(16/31), signiifcantly higher than 22%(9/40) in the CEUS group (χ2=6.489, P<0.05). The complete ablation rate was 100%(31/31) in the fusion imaging group and 95%(38/40) in the CEUS group , and no signiifcant difference was observed (P=0.501). Conclusions Both fusion imaging and simple CEUS are important methods for intraoperativ

关 键 词：超声检查 癌 肝细胞 消融技术 疗效比较研究 

分 类 号：R735.7[医药卫生—肿瘤]