经直肠超声造影对前列腺癌靶向冷冻消融术的疗效评价及指导生化复发干预的价值  

Evaluation of the effect of transrectal contrast-enhanced ultrasound for targeted cryoablation of prostate cancer and the value of guiding biochemical recurrence intervention

作　　者：陈翠 张时君[1] 李红丽[1] 李凤华[1] 谢少伟[1] 姜立新 CHEN Cui;ZHANG Shi-jun;LI Hong-li;LI Feng-hua;XIE Shao-wei;JIANG Li-xin(Department of Ultrasound,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院超声医学科,上海200127

出　　处：《中国临床医学影像杂志》2021年第8期540-543,共4页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金资助项目(编号:81901747)。

摘　　要：目的:探讨经直肠超声造影(Contrast-enhanced transrectal ultrasound,CETRUS)对局灶性前列腺癌靶向冷冻消融术的疗效评价及指导生化复发临床干预的价值。方法:2014年9月—2017年12月,对27例经前列腺穿刺病理证实为局灶性前列腺癌的患者行冷冻消融术治疗。术后定期监测前列腺特异性抗原(Prostate-specific antigen,PSA)。所有患者于术前和术后第1天、3月、6月、1年、之后每年及生化复发(术后PSA降到最低点后升高2 ng/mL)时行CETRUS检查。对比冷冻消融术前后的图像转归,评价消融效果。分析生化复发患者造影图像的变化,评价其在指导临床干预方面的价值。结果:27例患者均存活。术后第1天CETRUS示19例(70.4%)患者冷冻区内未见明显造影剂增强,8例(29.6%)见极少量造影剂微泡进入。术后6月CETRUS示消融灶边界清晰,未见明显造影剂进入。10例(37.0%)患者在随访中出现生化复发,其中4例CETRUS检查表现为阳性,CETRUS检查阳性组经间歇性内分泌治疗后,PSA水平下降,阴性组经主动监测示PSA水平保持稳定。结论:CETRUS可有效评价局灶性前列腺癌冷冻消融术的疗效、检出生化复发患者可疑复发灶,指导临床干预的选择。Objective:To investigate the effect of contrast-enhanced transrectal ultrasound(CETRUS)on targeted cryoablation of focal prostate cancer and its guiding value in clinical intervention for biochemical recurrence.Methods:From September 2014 to December 2017,cryoablation was performed on 27 patients with pathologically confirmed focal prostate cancer.Prostate-specific antigen(PSA)was monitored after therapy.All patients underwent CETRUS scanning before cryoablation,on the first day postoperatively,3 months,6 months,1 year and every year thereafter,or when biochemical recurrence(postoperative PSA dropped to the lowest point and then increased by 2 ng/mL).The image outcomes before and after cryoablation were compared to evaluate the ablation effect.The changes of images after biochemical recurrence were analyzed to evaluate its value in guiding clinical intervention.Results:All 27 patients survived.On the first day after therapy,CETRUS showed that there was no obvious contrast enhancement in the frozen area in 19 patients(70.4%),and a very small amount of contrast microbubbles were seen in 8 patients(29.6%).At six months after the operation,CETRUS showed no enhancement in the ablated areas.Biochemical recurrence were found in 10 patients(37.0%)during follow-up,and 4 cases of them were positive.After intermittent endocrine therapy,the PSA level of the 4 cases decreased,and another 6 remained stable PSA level by active surveillance.Conclusion:CETRUS is an effective imaging technology to evaluate cryoablation for localized prostate cancer,detect suspicious recurrence or metastasis in patients with biochemical recurrence,and guide the choice of clinical intervention.

关 键 词：前列腺肿瘤 冷冻外科手术 超声检查 介入性 

分 类 号：R737.25[医药卫生—肿瘤] R445.1[医药卫生—临床医学]