实时超声造影技术引导射频消融治疗70例肝细胞癌的临床分析

发布时间：2019-01-23 16:55

【摘要】：目的： 探讨实时超声造影技术在原发性肝癌射频消融治疗中应用的临床价值。 方法： 收集吉林大学第一医院肿瘤中心2012年9月到2013年6月期间在实时超声造影指导下进行肝癌射频消融术的70例原发性肝癌患者的临床资料，并选取2011年5月到2012年8月期间仅在普通超声引导下进行射频消融术的74例原发性肝癌患者作为对照，比较两组患者的临床特征（性别、年龄、Child分级、肿瘤大小、肿瘤数量等）、术前同CT/MRI检查的符合率、术后常见并发症（如发热、疼痛、血压升高、出血等）的发生情况。并对上述患者于术后1个月采用增强CT或（和）MRI等影像学检查进行疗效的评价，之后每3个月规律应用增强CT或（和）MRI进行随访，比较无进展生存情况。 结果： 超声造影组70例患者，超声造影表现为动脉期高增强56例（80.0%），增强CT/MRI表现动脉期增强53例（75.7%），其中超声造影同增强CT或MRI中有49例（70.0%）病灶增强模式表现一致（kappa=0.84）。超声造影界定病灶大小为（2.72±0.933）cm，大于应用普通超声的病灶大小界定范围（2.53±0.944）cm（P=0.042）。超声造影组患者术后发生并发症者34例（48.6%），对比普通超声造影组患者相关术后并发症为43例（58.1%），，两组无统计学意义（P0.05）。术后1个月应用CT或（和）MRI进行随访，超声造影组有6例病灶原位复发（8.6%），普通超声组18例出现原位复发（24.3%），二者比较具有统计学意义（χ2=6.427，P0.05）。两组患者的中位随访时间为12个月（4~16个月），超声造影组6个月无进展生存率为63.0%，普通超声组为45.3%；超声造影组1年无进展生存期为76.8%，普通超声组为70.6%。对比中位生存期，普通超声造影组为11.7个月，超声造影组未达到中位生存期。超声造影组无病生存期要长于对照组，具有统计学意义。针对病灶≥3cm的患者，6个月时造影组无进展生存率为74.8%，普通超声组为48.0%；1年超声造影组无进展生存期为68.0%，普通超声组为30.8%。对比中位生存期，普通超声造影组为6.6个月。超声造影组未达到中位生存期。超声造影组无病生存期要长于对照组，具有统计学意义（P0.05）。 结论： 超声造影可作为增强CT或MRI检查的有益补充。超声造影术中显影良好，可对射频消融术起到实时指导作用，减少肿瘤局部存活率，延长无病生存期，同时一定程度上减少相关并发症的发生。
[Abstract]:Objective: to evaluate the clinical value of real-time contrast-enhanced ultrasound in radiofrequency ablation of primary liver cancer. Methods: the clinical data of 70 patients with primary liver cancer undergoing radiofrequency ablation under the guidance of real-time contrast-enhanced ultrasound from September 2012 to June 2013 in the tumor Center of the first Hospital of Jilin University were collected. From May 2011 to August 2012, 74 patients with primary liver cancer undergoing radiofrequency ablation under the guidance of general ultrasound were selected as control group. The clinical features (sex, age, Child grade, tumor size) were compared between the two groups. The incidence of postoperative complications (such as fever, pain, elevated blood pressure, bleeding, etc.). The patients were evaluated with enhanced CT or / and MRI at 1 month after operation, and then followed up regularly with enhanced CT or / and MRI every 3 months. Results: in contrast echocardiography group, 56 cases (80.0%) showed high enhancement in arterial phase and 53 cases (75.7%) showed arterial phase enhancement in contrast enhanced CT/MRI. Contrast-enhanced ultrasonography was consistent with enhanced CT or MRI in 49 cases (70.0%). The size of the lesion was (2.72 卤0.933) cm, in contrast-enhanced ultrasound and (2.53 卤0.944) cm (P0.042) in the conventional ultrasound. The postoperative complications occurred in 34 cases (48.6%) in contrast group, compared with 43 cases (58.1%) in general contrast group. There was no significant difference between the two groups (P0.05). One month after operation, CT or / and MRI were used to follow up, 6 cases (8.6%) of lesions recurred in situ in contrast-enhanced ultrasound group and 18 cases (24.3%) in common ultrasound group. There was significant difference between the two groups (蠂 ~ 26.427, 蠂 ~ (2) 6.427). P0.05). The median follow-up time of the two groups was 12 months (4-16 months). The progression free survival rate was 63.0 in the contrast-enhanced ultrasound group and 45.3 in the general ultrasound group. The 1 year progression-free survival time was 76. 8 in contrast ultrasound group and 70.6 in general ultrasound group. The median survival time was 11.7 months in the conventional contrast echocardiography group, but the median survival time was not reached in the contrast-enhanced ultrasound group. The disease-free survival time of contrast-enhanced ultrasound group was longer than that of control group, which was statistically significant. For the patients with lesions 鈮

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