术中Sonazoid超声造影在特殊部位肝细胞癌经腹腔镜微波消融中的应用价值  

Application value of intraoperative Sonazoid-enhanced ultrasonography in laparoscopic microwave ablation of hepatocellular carcinoma in special locations

作　　者：段文斌 薛蓉 王子承 杨建辉[1] 毛先海[1] DUAN Wenbin;XUE Rong;WANG Zicheng;YANG Jianhui;MAO Xianhai(Department of Hepatobiliary Surgery,Hunan Provincial People’s Hospital/the First Affiliated Hospital of Hunan Normal University,Changsha 410002,China;Department of Ultrasonic Diagnosis,Hunan Provincial People’s Hospital/the First Affiliated Hospital of Hunan Normal University,Changsha 410002,China)

机构地区：[1]湖南省人民医院/湖南师范大学附属第一医院肝胆外科,湖南长沙410002 [2]湖南省人民医院/湖南师范大学附属第一医院超声科,湖南长沙410002

出　　处：《中国普通外科杂志》2022年第7期880-889,共10页China Journal of General Surgery

基　　金：湖南省卫健委省级疑难病诊疗中心建设基金资助项目(湘卫医政医管处便函[2019]118号)。

摘　　要：背景与目的:超声常用于引导微波消融(MWA)治疗肝细胞癌(HCC)。部分MWA可经皮完成,对于特殊部位HCC,则常选择通过腹腔镜完成。腹腔镜下MWA亦存在局限,对于小肝癌、等回声结节或合并肝硬化背景等情况,灰阶超声(GSUS)定位靶病灶常存在困难,此时可应用超声造影来增加病灶与肝实质的显影对比,提高靶病灶可视性。但目前临床常用的造影剂如声诺维等增强时间窗较短暂,因而在HCC消融术中的引导作用有限。Sonazoid于2019年在中国上市,相比其他造影剂,Sonazoid的优势在于其能被肝脏Kupffer细胞摄取,在注射造影剂约10 min后进入其特有的枯否相,此期肝脏实质显像增强,且文献报告枯否相可持续至少1 h。HCC因缺乏Kupffer细胞则呈低增强或增强缺失,因此,术中Sonazoid超声造影(S-CEUS)理论上有利于靶病灶的定位,且能为MWA提供充足的时间窗。本研究主要探讨S-CEUS相较于GSUS在针对特殊部位HCC行腹腔镜MWA术中对于肿瘤定位的优势,并分析S-CEUS对于消融治疗的实时引导作用。方法:连续选取2020年6月—2021年12月湖南省人民医院/湖南师范大学附属第一医院肝胆外科49例靶病灶位于特殊部位行腹腔镜MWA的HCC患者,术中分别行GSUS与S-CEUS,分析术中靶病灶的定位情况,采用5分信心量表法对靶病灶的可视度进行评分,比较GSUS与S-CEUS对靶病灶的可视度差异;同时观察靶病灶枯否相持续时间,以及在枯否相行MWA的效果。结果:49例患者术前MRI发现病灶56个,术中S-CEUS发现病灶59个,穿刺活检均证实为HCC。GSUS扫描时,靶病灶的可视度评分为2.86±0.96;S-CEUS动脉相,靶病灶的可视度评分为3.90±0.78;S-CEUS枯否相,靶病灶的可视度评分为4.25±0.60。S-CEUS动脉相、枯否相对靶病灶的可视度评分均优于GSUS (均P<0.001);S-CEUS枯否相对靶病灶的可视度评分优于S-CEUS动脉相(P<0.001)。靶病灶枯否相持续时间超过1 h;术前已知多个�Background and Aims:Microwave ablation(MWA) for the treatment of hepatocellular carcinoma(HCC) is often performed under ultrasound guidance.MWA in some cases can be completed via a percutaneous approach,while a laparoscopic approach is usually chosen for HCC in special locations.However,laparoscopic MWA also has limitations.For small HCC,isoechoic nodules or target lesions within a cirrhotic background,gray-scale ultrasound(GSUS) is sometimes difficult to locate the target lesions.At this time,contrast-enhanced ultrasound can be used to increase the contrast between the lesions and the liver parenchyma and improve the visibility of the target lesions.However,the time window of enhancement imaging with commonly used contrast agents such as Sono Vue is relatively short,so its guiding role in HCC ablation is limited.Sonazoid was approved for use in China in 2019.Compared with other contrast agents,the advantage of Sonazoid is that it can be phagocytosed by Kupffer cells in the liver and has its unique Kupffer phase about 10 min after the injection of contrast agent.At this stage,the ultrasonic imaging of liver parenchyma is enhanced,and previous literature has reported that that Kupffer phase can last for at least 1 h.Meanwhile HCC exhibits low enhancement or no enhancement due to the lack of Kupffer cells.Therefore,intraoperative contrast enhanced ultrasound with Sonazoid(S-CEUS) is theoretically helpful for the localization of the target lesions,and can provide a sufficient time window for MWA.This study was performed to investigate the advantages of S-CEUS in tumor localization compared with GSUS in laparoscopic MWA for HCC in special locations,and analyzed the real-time guiding capability of S-CEUS for ablation.Methods:From June 2020 to December 2021,49 HCC patients undergoing laparoscopic MWA with target lesions located in special areas in Department of Hepatobiliary Surgery,Hunan Provincial People’s Hospital/the First Affiliated Hospital of Hunan Normal University were consecutively selected.GSUS and S-CEUS

关 键 词：癌 肝细胞 消融技术 超声检查 造影剂 

分 类 号：R735.7[医药卫生—肿瘤]