超声造影引导下微波消融在常规超声显示困难小肝癌中的应用  

Application of contrast-enhanced ultrasound in microwave ablation of small hepatocellular carcinoma difficult to display on conventional ultrasonography

作　　者：王曦[1] 程朋[2] 何芬[1] 邓旦[1] 李东[2] WANG Xi;CHENG Peng;HE Fen(Department of Ultrasound,General Hospital of Chengdu Military Region,Chengdu 610083,China)

机构地区：[1]成都军区总医院超声科,成都610083 [2]成都军区总医院肿瘤诊疗中心,成都610083

出　　处：《临床肝胆病杂志》2018年第8期1697-1701,共5页Journal of Clinical Hepatology

基　　金：四川省科技厅科技支撑计划项目(2015FZ0073)

摘　　要：目的探讨超声造影引导下微波消融在常规超声显示困难小肝癌中的价值。方法回顾性分析2015年1月-2017年12月成都军区总医院肿瘤科常规超声显示困难的小肝癌患者的临床资料,所有患者增强CT示肝脏结节直径均<3.0 cm。所有患者术中实时超声造影确定肿瘤位置、大小,行微波消融。术后1个月行增强CT评价消融效果并观察有无重大并发症。分析患者术前相应部位的常规超声图像、增强CT图像、术中超声造影图像以及术后增强CT图像,评价疗效以及术后随访情况。结果共纳入52例患者,共78个病灶。超声造影下可直接显示73个病灶,5个病灶结合增强CT可明确,其中1个病灶为靠近膈肌及肝脏顶部、4个病灶为超声造影仅动脉相稍高增强。78个病灶微波消融均无重大并发症出现。术后1个月随访,78个病灶完全灭活。结论超声造影能够清晰显示常规超声显示困难小肝癌的位置、大小以及浸润范围,帮助微波消融准确定位,且术后并发症少,是微波消融的一项重要辅助手段。Objective To investigate the value of contrast-enhanced ultrasound in microwave ablation of small hepatocellular carcinoma difficult to display on conventional ultrasonography. Methods A retrospective analysis was performed for the clinical data of the patients with liver cancer difficult to display on conventional ultrasonography who were treated in Department of Oncology in General Hospital of Chengdu Military Region from January 2015 to December 2017,and according to the results of contrast-enhanced computed tomography（ CT）,all patients had a nodule diameter of 〈3. 0 cm. All patients were given contrast-enhanced ultrasound during microwave ablation to identify tumor location and size. Contrast-enhanced CT was performed at one month after surgery to evaluate the effect of ablation and the incidence of complications. For each lesion,conventional ultrasound images and contrast-enhanced CT images before surgery,contrast-enhanced ultrasound images during surgery,and contrast-enhanced CT images after surgery were analyzed to evaluate treatment outcome and postoperative follow-up. Results A total of 52 patients with 78 lesions were enrolled. Of all lesions,73 were directly displayed on contrast-enhanced ultrasound and 5 were clarified in combination with contrast-enhanced CT,among which one was located near the diaphragm and the top of the liver and four were only slightly enhanced in the arterial phase on contrast-enhanced ultrasound. Microwave ablation was performed for all 78 lesions,and no major complications were observed. Follow-up at one month after surgery showed that all 78 lesions were completely inactivated. Conclusion Contrast-enhanced ultrasound can clearly show the location,size,and extent of infiltration of small hepatocellular carcinoma lesions which are difficult to display on conventional ultrasonography. It also helps with accurate localization for microwave ablation and has fewer complications. Therefore,it is an important auxiliary method for microwave ablation.

关 键 词：肝肿瘤 血管造影术 超声检查 导管消融术 

分 类 号：R735.7[医药卫生—肿瘤]