病灶面积最大投影法用于CT引导下经皮肝肿瘤微波消融术
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摘要
目的探讨病灶面积最大投影法在CT引导下经皮肝肿瘤微波消融术中的应用价值。方法对23例肝肿瘤患者行CT引导下经皮肝肿瘤微波消融治疗,其中15例(研究组)在术中采用病灶面积最大投影法指导消融针穿刺并预测消融范围,8例(对照组)行常规CT引导下经皮微波消融。比较2组术中穿刺次数、术后并发症情况及近期疗效。结果研究组术中穿刺次数少于对照组[(1.27±0.46)次vs (3.62±0.74)次;t=-9.461,P<0.001]。2组患者术后并发症仅为肝包膜下出血,且研究组发生率低于对照组[6.67%(1/15) vs 37.50%(3/8);χ~2=3.976,P=0.041]。研究组术后6个月内肝肿瘤完全消融率明显高于对照组[93.33%(14/15) vs 50.00%(4/8);χ~2=5.647,P=0.017]。结论 CT引导下经皮肝肿瘤微波消融术中采用病灶面积最大投影法指导消融针穿刺并预测消融范围,有利于提高肿瘤完全消融率,同时减少并发症。
Objective To explore the application value of maximum projection method of lesion area in CT-guided percutaneous microwave ablation of liver tumor.Methods CT-guided percutaneous microwave ablation was performed on23 patients with liver tumor.All patients were divided into two groups.Fifteen patients underwent CT-guided percutaneous microwave ablation with maximum projection method of lesion area in study group,wihle 8 patients underwent CT-guided percutaneous microwave ablation with conventional method in control group.The times of puncture during operation,complications and the short-term efficacy of microwave ablation were compared between the two groups.Results Compared with control group,the times of puncture during operation decreased in study group([1.27±0.46]times vs[3.62±0.74]times;t=-9.461,P<0.001).No complication occurred after ablation except for subcapsular hemorrhage in both of the two groups,and the incidence of subcapsular hemorrhage in study group was lower than that in control group(6.67% [1/15]vs 37.50% [3/8];χ~2=3.976,P=0.041).Furthermore,the complete ablation rate of liver tumor in study group was higher than that in control group within 6 months after operation(93.33% [14/15]vs 50.00%[4/8];χ~2=5.647,P=0.017).Conclusion Maximum projection method of lesion area can be used to guide puncture and predict the ablation range during CT-guided percutaneous microwave ablation of liver tumors,which is helpful for the improvement of complete ablation rate and reducing complications.
Objective To explore the application value of maximum projection method of lesion area in CT-guided percutaneous microwave ablation of liver tumor.Methods CT-guided percutaneous microwave ablation was performed on23 patients with liver tumor.All patients were divided into two groups.Fifteen patients underwent CT-guided percutaneous microwave ablation with maximum projection method of lesion area in study group,wihle 8 patients underwent CT-guided percutaneous microwave ablation with conventional method in control group.The times of puncture during operation,complications and the short-term efficacy of microwave ablation were compared between the two groups.Results Compared with control group,the times of puncture during operation decreased in study group([1.27±0.46]times vs[3.62±0.74]times;t=-9.461,P<0.001).No complication occurred after ablation except for subcapsular hemorrhage in both of the two groups,and the incidence of subcapsular hemorrhage in study group was lower than that in control group(6.67% [1/15]vs 37.50% [3/8];χ~2=3.976,P=0.041).Furthermore,the complete ablation rate of liver tumor in study group was higher than that in control group within 6 months after operation(93.33% [14/15]vs 50.00%[4/8];χ~2=5.647,P=0.017).Conclusion Maximum projection method of lesion area can be used to guide puncture and predict the ablation range during CT-guided percutaneous microwave ablation of liver tumors,which is helpful for the improvement of complete ablation rate and reducing complications.
引文
[1] 中华医学会放射学分会介入学组.经皮肝脏肿瘤射频消融治疗操作规范专家共识.中华放射学杂志,2012,46(7):581-585.
[2] 国家肿瘤微创治疗产业技术创新战略联盟专家委员会,中国医师协会介入医学分会消融治疗专家工作指导委员会,北京医师协会介入医师分会.影像引导肝肿瘤热消融治疗技术临床规范化应用专家共识.中华医学杂志,2017,97(31):2420-2424.
[3] 张浩,范卫君,黄子,等.CT引导经皮微波消融治疗邻近横膈肝肿瘤的近期疗效及安全性分析.中华医学杂志,2014,94(17):1313-1317.
[4] 王喜功,潘吉荣,张峰.超声引导下经皮射频消融与微波消融治疗原发性肝细胞癌的比较.中国医学影像学杂志,2015,23(8):606-609.
[5] 袁强,王毅军,经翔,等.微波消融治疗肝脏恶性肿瘤的临床价值.中国肿瘤临床,2012,39(15):1104-1107.
[6] Lu MD, Xu HX, Xie XY, et al. Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: A retrospective comparative study. J Gastroenterol, 2005,40(11):1054-1060.
[7] 罗敏,时美欣,张巍,等.影响肝细胞癌射频消融术后疗效的相关因素分析.中华医学超声杂志(电子版),2015,12(6):453-461.
[8] 张宁宁,程晓静,刘建勇,等.大功率微波消融治疗肝癌临床疗效及其复发危险因素分析.实用肝脏病杂志,2015,18(3):249-253.
[9] Ke S, Ding XM, Qian XJ, et al. Radiofrequency ablation of hepatocellular carcinoma sized >3 and ≤5 cm: Is ablativemargin of more than 1 cm justified. World J Gastroenterol, 2013,19(42):7389-7398.
[10] 翟伟明,盛林,宋亦旭,等.基于影像引导的计算机辅助肝癌微波消融.计算机研究与发展,2011,48(2):281-288.
[2] 国家肿瘤微创治疗产业技术创新战略联盟专家委员会,中国医师协会介入医学分会消融治疗专家工作指导委员会,北京医师协会介入医师分会.影像引导肝肿瘤热消融治疗技术临床规范化应用专家共识.中华医学杂志,2017,97(31):2420-2424.
[3] 张浩,范卫君,黄子,等.CT引导经皮微波消融治疗邻近横膈肝肿瘤的近期疗效及安全性分析.中华医学杂志,2014,94(17):1313-1317.
[4] 王喜功,潘吉荣,张峰.超声引导下经皮射频消融与微波消融治疗原发性肝细胞癌的比较.中国医学影像学杂志,2015,23(8):606-609.
[5] 袁强,王毅军,经翔,等.微波消融治疗肝脏恶性肿瘤的临床价值.中国肿瘤临床,2012,39(15):1104-1107.
[6] Lu MD, Xu HX, Xie XY, et al. Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: A retrospective comparative study. J Gastroenterol, 2005,40(11):1054-1060.
[7] 罗敏,时美欣,张巍,等.影响肝细胞癌射频消融术后疗效的相关因素分析.中华医学超声杂志(电子版),2015,12(6):453-461.
[8] 张宁宁,程晓静,刘建勇,等.大功率微波消融治疗肝癌临床疗效及其复发危险因素分析.实用肝脏病杂志,2015,18(3):249-253.
[9] Ke S, Ding XM, Qian XJ, et al. Radiofrequency ablation of hepatocellular carcinoma sized >3 and ≤5 cm: Is ablativemargin of more than 1 cm justified. World J Gastroenterol, 2013,19(42):7389-7398.
[10] 翟伟明,盛林,宋亦旭,等.基于影像引导的计算机辅助肝癌微波消融.计算机研究与发展,2011,48(2):281-288.