常规超声与超声造影判断活体猪肝射频消融效果的实验研究

发布时间：2018-05-21 19:00

本文选题：肝脏 + 射频消融　；参考：《贵州医科大学》2017年硕士论文

【摘要】：目的探究常规超声与超声造影(contrast-enhanced ultrasound,CEUS)判断活体猪肝射频消融灶范围的价值以及超声造影判断活体猪肝射频消融灶是否完全消融的价值。方法选用10只小型活体猪肝在常规超声引导下进行射频消融(radiofrequency Ablation,RFA),然后在RFA结束后即刻予以常规超声扫描射频消融灶范围,选取射频消融灶在常规超声检查中的最大切面测量消融灶的左右径、垂直径,常规超声检查结束后即刻行超声造影检查,先予以常规超声扫描活体猪肝,选定射频消融灶扫描的最大切面,切换至造影模式,将超声造影剂经耳缘静脉团注,在CUES动脉期检查显示的射频消融灶最大切面中测量其左右径、垂直径,并且根据CEUS检查的动脉期、门脉期、延迟期消融灶影像学表现判断活体猪肝射频消融灶是否完全消融。在活体猪肝内射频消融实验结束后将实验小猪处死,解剖出整个活体猪肝,切取射频消融灶所在的肝叶或肝段,然后将射频消融灶切开并测量射频消融灶切面的左右径、垂直径。最后将射频消融灶所在肝叶或肝段的大体标本进行HE染色,在光学显微镜下行组织病理学检查判断射频消融灶内是否有正常肝细胞的残留。最后将常规超声、超声造影、大体标本所测量射频消融灶的左右径、垂直径、面积进行比较,以及将超声造影和大体标本判断射频消融灶是否完全消融的结果进行比较。结果本实验中共采用10只活体猪肝在常规超声引导下进行射频消融,共产生43个射频消融灶,其中活体猪肝射频消融灶在常规超声检查中所测量最大切面的左右径、垂直径、面积分别是3.27±0.51cm、2.81±0.50cm、7.20±1.59cm2,相应的在超声造影检查时所测量活体猪肝射频消融灶的左右径、垂直径、面积是分别是3.36±0.57cm、2.90±0.55cm、7.60±1.65cm2,相应射频消融灶所在肝叶或肝段大体标本所测量的左右径、垂直径、面积是3.40±0.60cm、2.88±0.55cm、7.66±1.79cm2,常规超声与超声造影、常规超声与大体标本所测量的射频消融灶范围结果比较差异均具有统计学意义(P均0.05),但是各测量值行线性相关性分析时相关性均较高;超声造影与大体标本测量射频消融灶范围结果比较差异均无统计学意义(P均0.05),而且各测量值行线性相关性分析时相关性均极高。以活体猪肝射频消融灶所在肝叶或肝段大体标本的组织切片病理检查结果为“金标准”,CEUS判断射频消融灶有15个表现完全消融,28个表现为不完全消融,而活体猪肝射频消融灶所在肝叶或肝段大体标本的组织切片病理检查结果判断有13个射频消融灶为完全消融,30个射频消融灶为不完全消融。因此,超声造影检查判断的结果中有5个完全消融灶和3个不完全消融灶与活体猪肝射频消融灶所在肝叶或肝段大体标本的组织切片病理检查结果不一致,因此,将组织切片病理检查结果为“金标准”时,超声造影检查判断消融灶残留的准确性为81.4%,敏感性83.3%,特异性76.9%,CEUS与大体标本的组织切片病理检查判断消融灶是否完全消融的结果相一致,McNemar检验P=0.7270.05差异无统计学意义。结论在RFA术后常规超声判断活体猪肝射频消融灶范围的价值有限,超声造影能够为RFA术后判断活体猪肝射频消融灶范围及是否完全消融提供可靠的影像学判断依据。
[Abstract]:Objective to explore the value of contrast-enhanced ultrasound (CEUS) to determine the range of radiofrequency ablation range in living pig liver and to determine the value of radiofrequency ablation in living pig liver by contrast-enhanced ultrasound. Methods radiofrequency ablation (radiofrequency Ablat) was performed under conventional ultrasound guidance in 10 small living pig liver (radiofrequency Ablat). Ion, RFA), then the radiofrequency ablation range was scanned by conventional ultrasonic scanning at the end of RFA, and the radiofrequency ablation range was selected to measure the left and right diameter of the ablation area, the vertical diameter, and the radiofrequency examination was performed immediately after the routine ultrasound examination. The maximum section of the sketch is switched to the contrast mode, and the ultrasound contrast agent is injected through the auricular vein, and the diameter and diameter of the radiofrequency ablation range are measured in the maximum section of the radiofrequency ablation range of the CUES arterial phase, and the radiofrequency ablation focus of the living pig liver is determined according to the CEUS examination of the arterial phase, the portal phase, and the delayed ablation range. At the end of the radiofrequency ablation experiment in living pig liver, the experimental pig was killed, the whole living pig liver was dissected, the liver leaf or liver segment of the radiofrequency ablation stove was cut, and the radiofrequency ablation range was cut and measured, and the vertical diameter of the radiofrequency ablation area was measured. Finally, the gross specimens of the liver and liver segments of the radiofrequency melting stove were stained with HE. To determine whether there is a normal liver cell in the radiofrequency ablation range under the optical microscope, and to compare the diameter, the vertical diameter and the area of the radiofrequency ablation range by conventional ultrasound, ultrasound contrast, and gross specimen, and to determine whether the radiofrequency ablation focus is completely ablation. Results the results were compared. Results there were 43 radiofrequency radiofrequency ablation of 10 living pig liver under conventional ultrasound guidance, and 43 radiofrequency ablation foci were produced. The diameter of the maximum section, vertical diameter, and area were 3.27 + 0.51cm, 2.81 + 0.50cm, 7.20 + 1.59cm2, in the routine ultrasound examination of the living pig liver radiofrequency ablation. The left and right diameter of the radiofrequency ablation foci of living pig liver were measured at 3.36 + 0.57cm, 2.90 + 0.55cm, 7.60 + 1.65cm2 respectively, and the vertical diameter was 3.40 + 0.60cm, 2.88 + 0.55cm, 7.66 + 1.79cm2, conventional ultrasound and super. There were significant differences in the range of radiofrequency ablation range measured by conventional ultrasound and general specimen (P 0.05), but the correlation was higher when the measured values were linear correlation analysis, and there was no significant difference between the radiofrequency ablation range and the gross specimen (P 0.05). The correlation between the measured values and the linear correlation analysis was very high. The pathological examination results of the tissue sections of the liver lobe or liver segment of the living pig liver radiofrequency ablation foci were "gold standard". CEUS showed that 15 radiofrequency ablation foci were completely ablation and 28 showed incomplete melting, while the liver lobes of living pig liver radiofrequency ablation foci were located in the liver. 13 radiofrequency ablation foci were completely ablation and 30 radiofrequency ablation foci were incomplete ablation. Therefore, there were 5 complete ablation and 3 incomplete ablation foci in the results of radiofrequency ablation in the liver and liver segments of the living pig liver. The results of pathological examination were inconsistent. Therefore, when the pathological examination results of tissue section were "gold standard", the accuracy of ultrasonic contrast examination was 81.4%, sensitivity 83.3% and specificity 76.9%. The results of CEUS and histological examination of gross specimens were consistent with the results of completely ablation of the ablation focus, McNemar examination. There is no statistical significance in the difference of P=0.7270.05 test. Conclusion the value of conventional ultrasound in determining the range of radiofrequency ablation range of living pig liver after RFA is limited, and the ultrasound contrast can provide a reliable basis for judging the range of radiofrequency ablation range and complete ablation of living pig liver after RFA.
【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R735.7

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