超声造影在经皮肝穿刺无水酒精治疗肝癌术中的应用研究

发布时间：2018-01-09 07:42

  本文关键词：超声造影在经皮肝穿刺无水酒精治疗肝癌术中的应用研究　出处：《浙江大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 无水酒精 超声造影 经皮肝穿注射无水酒精治疗 肝癌

【摘要】：目的： 将超声造影(contrast-enhanced ultrasound, CEUS)应用于经皮肝穿刺无水酒精治疗(percutaneous ethnol injection, PEI)肝癌术的术前、术中、术后,寻求PEI术治疗肝癌的量化方法,探讨超声造影的应用价值。 资料和方法： 研究对像为38例准备行PEI术治疗的肝癌患者,包括32例原发性肝细胞癌(hepatocellular carcinoma, HCC),2例肝内胆管细胞癌(Intrahepatic cholangio-carcinoma, ICC),4例转移性肝癌(metastatic liver cancer, MLC),男28例,女10例,年龄51-79岁,平均62.2岁。术前完善常规检查并超声造影,记录肝癌结节的位置、大小、血供特点,并据此规划PEI术中的进针点,布针方式,酒精用量等；术中行超声造影,在超声造影模式下引导酒精针的进入,并根据超声造影下肝癌结节的血供特点实时调整酒精针的位置,恰当布针,根据每枚酒精针的深度与位置,按先深后浅,先边缘高危部分后中心安全部位的顺序,依次缓慢注射无水酒精,实时观察无水酒精注入肝癌结节后的弥散情况,以无水酒精均匀弥散于肝癌结节并超出结节边缘1.0cm为标准,术中密切观注患者的生命体征；术后一周对患者复查肝功能及肿瘤指标,并行超声造影,评估治疗效果及肝脏损伤情况,决定是否重复上述PEI术过程,直至病人肝癌结节在超声造影状态下完全灭活视作治疗完成。详细记录患者PEI治疗的次数,总共所使用的酒精针数量,无水酒精的用量等,治疗过程不良反应发生情况,随访全部患者肝功能及肿瘤指标变化情况,半年及一年复发率及生存率。 结果： 1.全部38例患者共进行了100次PEI治疗,共使用PTC酒精针具297枚,无水酒精总使用量为752ml。PEI术治疗次数(N),PTC酒精针用量(M),无水酒精用量(V)均与肝癌结节最大径(D)呈显著正相关,回归方程分别为N=1.453D-0.9889(R=0.811, P0.001), M=5.613D-6.173(R=0.823, P0.001), V=8.022D-0.203(R=0.631, P0.001)。 2.在PEI术超声造影前对38例肝癌结节位置及大小、浸润范围的显示判断优于常规彩超,本组38例肝癌结节中10例常规彩超不能清晰显示,而超声造影显示清晰,另28例常规彩超声虽能显示,但其大小测量值与超声造影相比偏小；术中超声造影可以清晰显示肝癌结节的有血供的活性部分,精确引导无水酒精到达治疗靶点,而常规彩超无法做到；肝癌结节在PEI术后会产生多种声像图改变,常规彩超无法判断术后肝癌结节坏死灭活情况及复发情况,而术后超声造影可以显示肝实质及肝癌结节的血供情况,对PEI术的疗效做出准确的评估。 3.全部38例患者在治疗过程中无一例发生严重并发症,未发现因治疗引起肿瘤转移和局部播散,治疗过程中主要并发症有穿刺部分疼痛、发生率为78.9%,发热、发生率为21.1%,肝功能指标下降、发生率为15.8%,胸闷头晕、发生率为16.7%,腹部不适及呕吐、发生率为16.7%。 4.全部38例患者治疗完成后,32例原发性肝细胞癌患者肿瘤指标下降率为100%,转阴率为87.5%；2例肝内胆管细胞癌肿瘤指标1例转阴,1例下降未转阴；转移性肝癌肿瘤指标均有不同程度下降,下降率为100%,但均末见转阴。 5.本组38例患者半年及一年生存率分别为97.3%、89.5%,复发率分别为5.3%、13.2%。 结论： 应用超声造影,在PEI术前能够准确评估肿瘤大小、浸润范围、判断毗邻关系,可以帮助规划手术方式,术中可以准确引导并帮助精准消融病灶,术后可以客观评估治疗效果；超声造影技术的应用可量化指导PEI术治疗肝癌,有望提高PEI术治疗肝癌的效果。
[Abstract]:Objective:
Contrast-enhanced ultrasound (CEUS) was applied in the preoperative, intraoperative and postoperative percutaneous liver biopsy (percutaneous ethnol injection PEI) for the treatment of hepatocellular carcinoma.
Information and methods:
Study on Preparation and PEI treatment like 38 cases of liver cancer patients, including 32 cases of primary hepatocellular carcinoma (hepatocellular, carcinoma, HCC), 2 cases of intrahepatic cholangiocarcinoma (Intrahepatic, cholangio-carcinoma, ICC), 4 cases of metastatic liver cancer (metastatic liver, cancer, MLC), 28 cases were male, 10 female patients, age 51-79 years, average 62.2 years old. Perfect preoperative routine examination and ultrasonography, recording nodules location, size, blood supply, and the needle point according to this planning in PEI surgery, needle, alcohol dosage; intraoperative contrast-enhanced ultrasound, contrast-enhanced ultrasound guided mode in alcohol into the needle the adjustment for alcohol and needle position in real time according to the characteristics of blood liver nodules in ultrasound contrast, proper needle placement, according to the depth and position of each needle by alcohol, deep to shallow, the first part after the security center edge high-risk parts of the order, followed by slow injection of anhydrous alcohol. The observation of injecting anhydrous alcohol dispersion of liver nodules after, with anhydrous alcohol evenly dispersed in the nodules and nodules edge beyond the 1.0cm standard, with close attention of the vital signs of the patients; one week after the surgery of liver function in patients and tumor markers, parallel contrast-enhanced ultrasound, evaluating the therapeutic effect and liver injury, decision whether to repeat the above process until PEI surgery, patients of liver nodules in ultrasound contrast state completely inactivated as treatment is completed. The number of detailed records of patients with PEI treatment, the total number of needles used by alcohol, anhydrous alcohol dosage, the occurrence of adverse reactions during the treatment and follow-up of all patients with liver function and tumor index changes, the first half and one year recurrence rate and survival rate.
Result锛，

本文编号：1400577