超声引导下微波消融技术在局限性结核病变治疗中的价值分析  

The value of ultrasound-guided microwave ablation in the treatment of localized tuberculous lesions

作　　者：阎庆虎 薛峰[2] 于泳 秦毅 阎庆梅 崔嘉 Yan Qinghu;Xue Feng;Yu Yong;Qin Yi;Yan Qingmei;Cui Jia(Ultrasound Department of Shandong Public Health Clinical Center,Ji’nan 250013,China;Department of Radiology,Qilu Hospital,Shandong University,Ji’nan 250012,China;Ultrasound Department of Shandong First Medical University Affiliated Provincial Hospital,Ji’nan 250000,China;Emergency Department of Shizhong District People’s Hospital,Ji’nan 250000,China)

机构地区：[1]山东大学附属公共卫生临床中心/山东省公共卫生临床中心超声科,济南250013 [2]山东大学齐鲁医院放射科,济南250012 [3]山东第一医科大学附属省立医院超声科,济南250000 [4]济南市市中区人民医院急诊科,济南250000

出　　处：《结核与肺部疾病杂志》2025年第1期55-60,共6页Journal of Tuberculosis and Lung Disease

基　　金：山东省医药卫生科技项目(面上项目)(202309020993)。

摘　　要：目的:探讨在常规内科结核药物治疗的基础上,利用超声引导下微波消融技术在局限性结核病变治疗中的应用价值。方法:回顾性分析2020年3月至2023年1月在山东省公共卫生临床中心和山东第一医科大学附属省立医院行超声引导下微波消融治疗的12例局限性结核病变患者,包括淋巴结结核6例、胸壁结核4例、肝脏结核2例。所有患者的局限性结核灶在微波消融后,行超声造影检查,消融后,3、6、9、12、24个月进行随访,测量消融灶体积,统计消融灶体积缩小率,评价消融效果。结果:消融术后,12例局限性结核患者的15个结核病灶超声造影均显示完全消融,术后3、6、9、12、24个月进行随访,消融灶体积分别为2.82(1.62,5.85)cm^(3)、1.95(1.54,4.59)cm^(3)、1.62(0.15,4.02)cm^(3)、1.52(0.00,3.98)cm^(3)、0.00(0.00,1.64)cm^(3),消融灶缩小率分别为51(36,59)%、62(52,72)%、69(58,97)%、71(62,100)%、100(72,100)%,8个消融灶随访期内消失。术后24个月消融灶缩小率与术后3、6、9、12个月比较,差异均有统计学意义(χ^(2)值分别为-3.41、-3.18、-3.06、-2.52,P值分别为0.001、0.001、0.002、0.012)。术中及术后所有患者均未出现周围脏器损伤、针道种植及结核播散等并发症,随访期未发现活动性进展或复发。结论:超声引导下微波消融治疗局限性结核病变具有较高的价值,值得临床推广。Objective:This study aims to evaluate the clinical efficacy and potential applications of ultrasound-guided microwave ablation as an adjunct to conventional anti-tuberculosis pharmacotherapy in the management of localized tuberculous lesions.Methods:A retrospective analysis was conducted on 12 patients with localized tuberculous lesions who underwent ultrasound-guided microwave ablation at the Shandong Public Health Clinical Center and the Shandong First Medical University Affiliated Provincial Hospital between March 2020 and January 2023.The cohort included 6 cases of lymph node tuberculosis,4 cases of chest wall tuberculosis,and 2 cases of liver tuberculosis.Contrast-enhanced ultrasound(CEUS)was performed post-ablation for all patients to evaluate treatment efficacy.Follow-up assessments were carried out at 3,6,9,12,and 24 months post-ablation to measure the ablation lesion volume and calculate its reduction rate.Data were expressed as median(interquartile range,M(P25,P75))and analyzed using the Z-test to assess the effectiveness of the ablation procedure.Results:Contrast-enhanced ultrasound confirmed complete ablation in all 15 localized tuberculous lesions across 12 patients immediately after the procedure.During follow-up at 3,6,9,12,and 24 months post-ablation,the median lesion volumes were recorded as 2.82(1.62,5.85)cm^(3),1.95(1.54,4.59)cm^(3),1.62(0.15,4.02)cm^(3),1.52(0.00,3.98)cm^(3),0.00(0.00,1.64)cm^(3),respectively.Correspondingly,the shrinkage rates of the ablation lesions were 51(36,59)%,62(52,72)%,69(58,97)%,71(62,100)%,100(72,100)%.By the end of the follow-up period,8 ablation lesions had completely resolved.The reduction rate of ablation lesions at 24 months post-surgery was significantly higher compared to those at 3,6,9,and 12 months,with correspondingχ^(2) values of-3.41,-3.18,-3.06,and-2.52(P=0.001,0.001,0.002,and 0.012,respectively).No complications,such as peripheral organ damage,needle track implantation,or tuberculosis dissemination,were observed during or after the procedure.Furthermo

关 键 词：结核 超声检查 介入性 治疗应用 

分 类 号：R52[医药卫生—内科学]