热消融治疗血管旁肝癌残留的影响因素分析  

Influencing Factors for Tumor Residue of Perivascular Hepatocellular Carcinoma Following Ultrasound-guided Thermal Ablation

作　　者：骆永利 胡巧洪[2] 何晓东[2] 范小明 LUO Yong-li;HU Qiao-hong;HE Xiao-dong;FAN Xiao-ming(Graduate School of Bengbu Medical College,Bengbu 233030,China;Zhejiang Provincial People's Hospital/People's Hospital of Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]蚌埠医学院研究生院,安徽蚌埠233030 [2]浙江省人民医院(杭州医学院附属人民医院),浙江杭州310014 [3]浙江省人民医院(杭州医学院附属人民医院)超声科,浙江省杭州市310014

出　　处：《肿瘤学杂志》2021年第5期383-389,共7页Journal of Chinese Oncology

基　　金：浙江省卫生健康委员会科研基金项目(2017KY206)。

摘　　要：[目的]探讨超声引导下热消融治疗血管旁肝癌后残留的影响因素。[方法]回顾性分析2017年1月至2020年5月行超声引导下热消融治疗肝癌患者198例,共274枚肿瘤,其中位于血管旁肝癌73枚(以下称血管旁组),非血管旁肝癌201枚(以下称非血管旁组)。用热消融术后1~3个月内的增强MRI判定病灶是否残留。比较两组病灶的残留率;同时分析性别、年龄、肝硬化史、肝功能分级、肝脏手术史、原发性与转移性肿瘤、肿瘤最大径、消融方式、消融时间、瘤旁血管类型、直径、术中超声造影显示残留后补充消融对血管旁肝癌残留率的影响。[结果]274枚肿瘤中,27枚残留,残留率为9.9%,其中血管旁组残留率为16.4%(12/73),非血管旁组残留率为7.5%(15/201),两组间比较差异有统计学意义(χ2=4.857,P=0.028)。血管旁组中,最大径≤3cm的肿瘤残留率为9.6%,>3cm的肿瘤残留率为33.3%;肝静脉旁肝癌残留率为7.9%,门静脉旁肝癌残留率为25.7%;瘤旁血管直径≤5mm时残留率为8.7%,>5mm时残留率为29.6%;术中超声造影显示残留后补充消融时残留率为9.3%,术中未行超声造影时残留率为36.8%。多因素分析显示,肿瘤最大径>3cm(OR=5.930,95%CI:1.321~26.626)或肿瘤位于门静脉旁(OR=5.678,95%CI:1.108~29.095)术后残留风险增加;术中超声造影显示残留后补充消融(OR=0.155,95%CI:0.035~0.682),术后残留风险降低。[结论]热消融治疗血管旁肝癌较非血管旁肝癌更易残留。肿瘤最大径>3cm或位于门静脉旁的血管旁肝癌是残留的高风险因素;术中超声造影显示残留后补充消融是减少残留的有效措施。[Objective]To investigate influencing factors for tumor residue of perivascular hepatocellular carcinoma following ultrasound-guided thermal ablation.[Methods]Clinical and imaging data of 198 patients with hepatocellular carcinoma who underwent ultrasound-guided thermal ablation from January 2017 to May 2020,were retrospective analyzed.There were a total of 274 tumors in 198 patients,including 73 perivascular tumors(perivascular group),and 201 non-perivascular tumors(non-perivascular group).For some patients the intraoperative contrast-enhanced ultrasonography was performed and supplemental ablation was given for residual tumors.The residual tumors were detected by follow-up enhance MRI within 1~3 months after thermal ablation,and the residual rate of the two groups were compared.The relationship of tumor residue with the gender,age,history of cirrhosis,Child-Pugh class,history of liver operation,primary and metastatic tumors,tumor maximum diameter,ablation method,ablation time,type of blood vessel adjacent to tumor,the diameter of blood vessel adjacent to tumor,and intraoperative contrast-enhanced ultrasonography was analyzed.[Results]Among 274 tumors of 198 patients,27 lesions remained after ablation with a residual rate of 9.9%.The residual rate of perivascular group was higher than that of non-perivascular group[16.4%(12/73)vs.7.5%(15/201),χ2=4.857,P=0.028].In the perivascular group,the residual rate of the tumor with maximum diameter<3 cm and>3 cm were 9.6%and 33.3%;the residual rate of tumor adjacent to the hepatic vein and the portal vein were 7.9%and 25.7%;while for adjacent vessel diameter≤5 mm and>5 mm,the residual rate were 8.7%or 29.6%,respectively.And the residual rate was 9.3%for patients having intraoperative contrast-enhanced ultrasonography,and that was 36.8%for those without intraoperative contrast-enhanced ultrasonography.Multivariate analysis showed that the maximum diameter of the tumor>3 cm(OR=5.930,95%CI:1.321~26.626,P<0.05)and the tumor adjacent to portal vein(OR=5.678,95%CI:1.108~29.09

关 键 词：肝癌 热消融术 血管 残留肿瘤 

分 类 号：R735.7[医药卫生—肿瘤]