超声融合成像在联合手术或操作的肝肿瘤消融术中疗效评估的应用

发布时间：2018-01-01 19:34

本文关键词：超声融合成像在联合手术或操作的肝肿瘤消融术中疗效评估的应用　出处：《中山大学学报(医学科学版)》2017年05期 　论文类型：期刊论文

【摘要】：【目的】比较超声(US)与计算机断层扫描(CT)或磁共振(MR)的融合成像(US-CT/MR融合成像)以及超声与三维超声融合(US-US融合成像)在联合其他手术或操作的肝肿瘤消融术中疗效评估应用的价值。【方法】本研究纳入2015年8月至2015年12月期间联合其他手术或操作(包括开腹手术、腹腔镜手术、人工胸腹水等)的肝肿瘤消融治疗患者,分别对同一患者采用US-CT/MR融合成像和US-US融合成像结合超声造影进行术中即时消融疗效评估,比较两种融合成像技术适用率、融合配准成功率及操作时间。术后观察并记录并发症发生情况,消融术后1~3月行增强CT/MR作为疗效评估金标准。【结果】共50例患者合计67个病灶纳入本研究,其中包括消融联合人工胸腹水37例47个病灶,联合开腹手术10例14个病灶,腹腔镜手术5例8个病灶。US-US融合成像技术适用率为52.5%(35/67),显著低于US-CT/MR融合成像技术适用率[98.7%(66/67)](P0.001);而US-US融合成像的配准成功率为88.6%(31/35),显著高于US-CT/MR融合成像配准成功率[66.7%(44/66)](P=0.018)。US-US融合成像操作时间[3.8 min(2.7~10.0 min)]显著短于US-CT/MR融合成像[5.5 min(3.0~14.0 min)](P0.001)。随访期内均未发现消融相关主要并发症,术后1~3个月内复查增强CT/MR,消融技术有效率为100%(62/62)。【结论】对于术中联合其他手术或操作的肝肿瘤消融术,病灶超声显示清楚者优先选择US-US融合成像,尤其是联合开腹手术的患者;而病灶超声显示不清时,部分患者也可选择US-CT/MR融合成像。
[Abstract]:[objective] to compare the fusion imaging of USUS with computed tomography (CT) or magnetic resonance imaging (MRM), and the fusion imaging of ultrasound with 3D ultrasound. US-US fusion imaging). Value of evaluation of efficacy in combination with other operations or procedures for hepatic tumor ablation. [methods] this study was included in the period from August 2015 to December 2015 in combination with other operations or procedures. Including open surgery. Laparoscopic surgery, artificial pleural effusion, etc.) in patients with liver tumor ablation. US-CT/MR fusion imaging and US-US fusion imaging combined with contrast-enhanced ultrasound were used to evaluate the immediate ablation effect in the same patient, and the rate of application of the two fusion imaging techniques was compared. Fusion registration success rate and operation time. Postoperative complications were observed and recorded. From 1 to March after ablation, enhanced CT/MR was used as the criteria for evaluation of therapeutic effect. [results] 67 lesions were included in this study in 50 patients. These included 37 lesions in 37 patients with artificial hydrothorax and ascites, and 14 lesions in 10 patients with combined laparotomy. The applicable rate of 5 cases of laparoscopic surgery with 8 foci. US-US fusion imaging technique was 52.5% 35 / 67, which was significantly lower than that of US-CT/MR fusion imaging technique. [P 0.001; The registration success rate of US-US fusion imaging is 88.6 / 35, which is significantly higher than that of US-CT/MR fusion imaging registration. [66.7b / 44 / 66] Pu 0.018U. US-US fusion imaging operation time. [3. 8 min(2.7~10.0)] is significantly shorter than US-CT/MR fusion imaging. [5.5 min(3.0~14.0 / min] P 0.001g. No major complications associated with ablation were found during the follow-up period, and enhanced CT/MR was reexamined within 1 ~ 3 months after operation. The effective rate of ablation technique is 100 / 62%. [conclusion] US-US fusion imaging is preferred for liver tumor ablation combined with other surgery or operation. Especially the patients with combined laparotomy; However, some patients may choose US-CT/MR fusion imaging when the focus is not clear.
【作者单位】：中山大学附属第三医院超声科//广东省肝脏疾病研究重点实验室;
【基金】：国家自然科学基金(81401434,81430038) 广东省科技计划项目(2017A020215082,2014A020212136) 广东省产学研项目(2013B090200020)
【分类号】：R445.1;R735.7
【正文快照】： 超声(ultrasound,US)融合成像技术是介入超声领域中的一种新技术,主要是基于电磁感应系统、三维重建技术等实现超声与其他影像学图像或三维超声(three-dimensional ultrasound,3DUS)图像的融合[1-3],这一技术在一定程度上克服了普通超声对病灶诊断的敏感性较低、扫查视野受限

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