超声引导经皮胆囊息肉组织活检及射频消融术临床应用初探  

Clinical application of percutaneous ultrasonography-guided gallbladder polyp biopsy and radiofrequency ablation:a primary study

作　　者：刘婷婷[1] 董刚[1] 靳水玲 吴洁[1] 孙璐璐[1] 张姗姗[1] 孙嘉敏 Liu Tingting;Dong Gang;Jin Shuiling;Wu Jie;Sun Lulu;Zhang Shanshan;Sun Jiamin(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Oncology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院超声科,450000 [2]郑州大学第一附属医院肿瘤科,450000

出　　处：《中华超声影像学杂志》2021年第9期792-799,共8页Chinese Journal of Ultrasonography

基　　金：河南省医学科技攻关计划项目(LHGJ20190158)。

摘　　要：目的分析超声引导经皮穿刺胆囊息肉组织活检及射频消融术临床应用的可行性和疗效。方法纳入2019年4月至2021年1月于郑州大学第一附属医院超声科行超声引导下胆囊息肉活检术和射频消融术的患者25例,共29枚息肉,病灶最大径11.00(10.00,12.50)mm,全麻下超声引导下胆囊壁浆膜层下注水至胆囊壁水肿增厚≥10 mm,行经皮胆囊息肉活检术及射频消融术,消融息肉及息肉附着处胆囊黏膜层。术中超声造影评估是否需要补充消融。记录手术时间及术中术后情况,评估胆囊息肉完全消融率、消融后病灶体积缩小率、并发症发生率以及手术对胆囊壁厚度和胆囊收缩率的影响。结果25例患者成功完成胆囊息肉活检术及射频消融术。活检病理胆固醇息肉14例,腺瘤5例,炎性息肉5例,胆囊腺肌症1例。29枚胆囊息肉呈消融后改变,病灶体积不同程度缩小。第1,3,6个月消融灶体积缩小率分别为70.74%(58.55%,77.56%)、89.47%(85.04%,96.87%)、100%(95.68%,100%),差异有统计学意义(均P<0.05)。胆囊壁厚度及胆囊收缩率术前与术后1个月差异无统计学意义(P>0.05)。手术时间为14~39(23.32±6.68)min。术中3例(12.0%)患者出现一过性心率下降,术后2例(8.0%)患者出现轻微腹痛,1例(4.0%)患者出现明显腹痛,均处理后缓解。无出血、胆囊穿孔、腹腔感染等严重并发症出现。随访1~22[6(3,7)]个月,无患者失访,无息肉复发及新生息肉,未见继发性胆囊结石出现。结论超声引导下胆囊息肉的组织活检及射频消融术在保留胆囊功能的前提下明确息肉性质并局部灭活息肉,并发症发生率低,有可操作性,是胆囊息肉保胆治疗的一个可行选择。Objective To analyze the feasibility and efficacy of ultrasound-guided percutaneous biopsy and radiofrequency ablation of gallbladder polyps.Methods From April 2019 to January 2021,25 patients with gallbladder polyps underwent ultrasound-guided biopsy and radiofrequency ablation in the ultrasound department of the First Affiliated Hospital of Zhengzhou University were collected,the maximum diameter of the lesion was 11.00(10.00,12.50)mm.Under general anesthesia,ultrasound-guided injection of water into the gallbladder serosa layer was performed to make the gallbladder edema thicker than or equal to 10 mm.Percutaneous biopsy and radiofrequency ablation of gallbladder polyps were performed to ablate the gallbladder mucosa layer of polyps and polyp attachment.Intraoperative contrast-enhanced ultrasound was used to evaluate the need for supplementary ablation.The operation time,intraoperative and postoperative conditions were recorded.The complete ablation rate of gallbladder polyps,the reduction rate of lesion volume after ablation,the incidence of complications and the effect of operation on gallbladder wall thickness and gallbladder contraction rate were evaluated.Results Biopsy and radiofrequency ablation of gallbladder polyps were successfully performed in 25 patients.There were 14 cases of cholesterol polyp,5 cases of adenoma,5 cases of inflammatory polyp and 1 case of gallbladder adenomyosis.Twenty-nine gallbladder polyps showed changes after ablation,and the lesion volume was reduced to varying degrees.In the first,third and sixth months,the volume reduction rates of ablation focus were 70.74%(58.55%,77.56%),89.47%(85.04%,96.87%)and 100%(95.68%,100%)respectively,and the differences were statistically significant(P<0.05).There were no significant differences in gallbladder wall thickness and gallbladder contraction rate before and 1 month after operation(P>0.05).The operation time was 14-39(23.32±6.68)min.During the operation,3 patients(12.0%)had a decrease in heart rate,2 patients(8.0%)had mild abdominal pai

关 键 词：超声引导 射频消融 胆囊 胆囊息肉 组织活检 

分 类 号：R657.4[医药卫生—外科学]