观察超声造影在肝癌微波消融治疗中的应用价值
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摘要
目的探讨超声造影在肝癌(hepatocellular carcinoma,HCC)微波消融治疗中的应用效果及价值.方法取2014-12/2016-11衢州市柯城区人民医院超声科收治的HCC患者100例,随机数字法分为对照组(n=50)和观察组(n=50).2组均采用微波消融法治疗,对照组在常规超声下实施微波消融治疗,观察组在超声造影下实施微波消融治疗,比较2组临床疗效.结果观察组微波消融后消融率明显高于对照组(95.24%vs 76.71%),差异有统计学意义(P<0.05);连续对2组患者进行6 mo随访,结果表明:观察组除3例未完全消融外,还有1例患者超声造影和计算机扫描检查病灶呈强化状态,需要再次进行微波消融治疗;对照组4例患者病灶周边呈异常增强显效,2例为明显增强,2例为轻度增强.观察组微波消融后并发症发生率明显低于对照组(6.00%vs 14.00%),差异有统计学意义(P<0.05).结论 HCC患者采用微波消融治疗时实施超声造影效果理想,能清晰的显示病灶位置、大小、边界及病灶的数目,指导临床治疗,值得推广应用.
AIM To evaluate the value of contrast-enhanced ultrasono-graphy in microwave ablation of liver cancer.METHODS One hundred patients with hepatocellular carcinoma(HCC) were enrolled in this study from December 2014 to November 2016. They were randomly divided into either a control group(n = 50) or an observation group(n = 50). Both groups were treated by microwave ablation. The control group was treated by microwave ablation under the guidance of routine ultrasound. The observation group was treated by microwave ablation under the guidance of contrast-enhanced ultrasonography. The clinical efficacy of the two groups was compared.RESULTS The ablation rate after microwave ablation in the observation group was significantly higher than that in the control group(95.24% vs 76.71%, P < 0.05). The patients in both groups were followed for 6 mo continuously. The results showed that in the observation group, three cases had incomplete ablation, and one case had enhanced lesions and needed microwave ablation again. Four patients in the control group showed peripherally abnormally enhanced lesions, including two cases of significant enhancement and two cases of mild enhancement. The incidence of complications after microwave ablation was significantly lower in the observation group than in the control group(6.00% vs 14.00%, P < 0.05).CONCLUSION The results of ultrasound ablation in patients with HCC can be clearly showed by the method of contrastenhanced ultrasonography, and the location, size, border, and number of lesions can be clearly demonstrated.
AIM To evaluate the value of contrast-enhanced ultrasono-graphy in microwave ablation of liver cancer.METHODS One hundred patients with hepatocellular carcinoma(HCC) were enrolled in this study from December 2014 to November 2016. They were randomly divided into either a control group(n = 50) or an observation group(n = 50). Both groups were treated by microwave ablation. The control group was treated by microwave ablation under the guidance of routine ultrasound. The observation group was treated by microwave ablation under the guidance of contrast-enhanced ultrasonography. The clinical efficacy of the two groups was compared.RESULTS The ablation rate after microwave ablation in the observation group was significantly higher than that in the control group(95.24% vs 76.71%, P < 0.05). The patients in both groups were followed for 6 mo continuously. The results showed that in the observation group, three cases had incomplete ablation, and one case had enhanced lesions and needed microwave ablation again. Four patients in the control group showed peripherally abnormally enhanced lesions, including two cases of significant enhancement and two cases of mild enhancement. The incidence of complications after microwave ablation was significantly lower in the observation group than in the control group(6.00% vs 14.00%, P < 0.05).CONCLUSION The results of ultrasound ablation in patients with HCC can be clearly showed by the method of contrastenhanced ultrasonography, and the location, size, border, and number of lesions can be clearly demonstrated.
引文
1冯建新,高万河,蒋俊,李俊杰,刘曙民.大功率微波消融对中晚期肝癌的近期疗效观察.实用放射学杂志2015;31:2025-2028
2葛乃建,黄剑,杨业发,李俊杰,刘曙民.经内镜鼻胆管引流术胆管冷却保护技术在肝癌微波消融中的应用.中华消化内镜杂志2016;33:277-281
3周忠斌,李永杰.超声引导微波消融治疗原发性肝癌合并动静脉瘘的疗效观察.中华超声影像学杂志2015;24:968-971[DOI:10.3760/cma.j.issn.1004-4477.2015.11.012]
4 Zhang J,Zhu Z,Sun Z,Sun X,Wang Z,Xu H.Survivin gene expression increases gastric cancer cell lymphatic metastasis by upregulating vascular endothelial growth factor-C expression levels.Mol Med Rep 2014;9:600-606[PMID:24337012 DOI:10.3892/mmr.2013.1858]
5申文凤,冯志强,张洪义,邹玉锋,李新慧,肖梅,赵刚.超声联合三维影像技术在微波消融治疗大肝癌中的应用.中华肝胆外科杂志2016;22:509-512[DOI:10.3760/cma.j.issn.1007-8118.2016.08.002]
6唐田,古善智,李国文,黄满平,黄斌,熊正平.CT引导下微波消融治疗肝癌术后复发的疗效分析.中国介入影像与治疗学2015;12:657-660
7乔强,李海莹,吴佳恒,程文.人工腹水下射频消融和微波消融治疗毗邻重要器官的肝癌.中国微创外科杂志2016;16:724-727[DOI:10.3969/j.issn.1009-6604.2016.08.013]
8 Hu J,Pan J,Luo Z,Tao Z.Downregulation of Survivin by sh RNA Inhibits Invasion and Enhances the Radiosensitivity of Laryngeal Squamous Cell Carcinoma.Cell Biochem Biophys 2015;72:251-257[PMID:25701406 DOI:10.1007/s12013-014-0445-z]
9张喜君,王绮,袁建军,杨龙.超声造影对小肝癌多电极冷循环射频消融的近期疗效评估.中国介入影像与治疗学2015;12:10-13
10钟丽云,蒋天安,赵齐羽,陈芬,邓壮,鲍海威.影像融合超声造影技术对常规超声及超声造影显示不清肝癌的诊治价值.中华超声影像学杂志2015;24:963-967[DOI:10.3760/cma.j.issn.1004-4477.2015.11.011]
11张奥华,徐净.融合成像导航计划系统辅助肝癌射频消融的临床初步研究.实用医学杂志2015;31:641-644[DOI:10.3969/j.issn.1006-5725.2015.04.041]
12 Shirakawa K,Kobayashi H,Sobajima J,Hashimoto D,Shimizu A,Wakasugi H.Inflammatory breast cancer:vasculogenic mimicry and its hemodynamics of an inflammatory breast cancer xenograft model.Breast Cancer Res 2003;5:136-139[PMID:12793894 DOI:10.1186/bcr585]
13张晓儿,徐明,谢晓燕,丛龙飞,孙腾,叶洁仪,吕明德,黄光亮.采用三维超声造影配准技术快速判断肝癌消融疗效的初步研究.中华超声影像学杂志2016;25:502-505[DOI:10.3760/cma.j.issn.1004-4477.2016.06.010]
14杨洁,张学兰.超声造影与声辐射力脉冲成像技术在肝脏占位性病变鉴别诊断中的应用价值.中国超声医学杂志2015;31:518-520
15王强,闫军,冯晓彬,陈耿,夏锋,李晓武,马宽生,别平.补救性射频消融或门静脉栓塞术联合射频辅助肝脏分隔和门静脉结扎的二步肝切除术治疗肝硬化肝癌.中华消化外科杂志2016;15:455-460[DOI:10.3760/cma.j.issn.1673-9752.2016.05.011]
2葛乃建,黄剑,杨业发,李俊杰,刘曙民.经内镜鼻胆管引流术胆管冷却保护技术在肝癌微波消融中的应用.中华消化内镜杂志2016;33:277-281
3周忠斌,李永杰.超声引导微波消融治疗原发性肝癌合并动静脉瘘的疗效观察.中华超声影像学杂志2015;24:968-971[DOI:10.3760/cma.j.issn.1004-4477.2015.11.012]
4 Zhang J,Zhu Z,Sun Z,Sun X,Wang Z,Xu H.Survivin gene expression increases gastric cancer cell lymphatic metastasis by upregulating vascular endothelial growth factor-C expression levels.Mol Med Rep 2014;9:600-606[PMID:24337012 DOI:10.3892/mmr.2013.1858]
5申文凤,冯志强,张洪义,邹玉锋,李新慧,肖梅,赵刚.超声联合三维影像技术在微波消融治疗大肝癌中的应用.中华肝胆外科杂志2016;22:509-512[DOI:10.3760/cma.j.issn.1007-8118.2016.08.002]
6唐田,古善智,李国文,黄满平,黄斌,熊正平.CT引导下微波消融治疗肝癌术后复发的疗效分析.中国介入影像与治疗学2015;12:657-660
7乔强,李海莹,吴佳恒,程文.人工腹水下射频消融和微波消融治疗毗邻重要器官的肝癌.中国微创外科杂志2016;16:724-727[DOI:10.3969/j.issn.1009-6604.2016.08.013]
8 Hu J,Pan J,Luo Z,Tao Z.Downregulation of Survivin by sh RNA Inhibits Invasion and Enhances the Radiosensitivity of Laryngeal Squamous Cell Carcinoma.Cell Biochem Biophys 2015;72:251-257[PMID:25701406 DOI:10.1007/s12013-014-0445-z]
9张喜君,王绮,袁建军,杨龙.超声造影对小肝癌多电极冷循环射频消融的近期疗效评估.中国介入影像与治疗学2015;12:10-13
10钟丽云,蒋天安,赵齐羽,陈芬,邓壮,鲍海威.影像融合超声造影技术对常规超声及超声造影显示不清肝癌的诊治价值.中华超声影像学杂志2015;24:963-967[DOI:10.3760/cma.j.issn.1004-4477.2015.11.011]
11张奥华,徐净.融合成像导航计划系统辅助肝癌射频消融的临床初步研究.实用医学杂志2015;31:641-644[DOI:10.3969/j.issn.1006-5725.2015.04.041]
12 Shirakawa K,Kobayashi H,Sobajima J,Hashimoto D,Shimizu A,Wakasugi H.Inflammatory breast cancer:vasculogenic mimicry and its hemodynamics of an inflammatory breast cancer xenograft model.Breast Cancer Res 2003;5:136-139[PMID:12793894 DOI:10.1186/bcr585]
13张晓儿,徐明,谢晓燕,丛龙飞,孙腾,叶洁仪,吕明德,黄光亮.采用三维超声造影配准技术快速判断肝癌消融疗效的初步研究.中华超声影像学杂志2016;25:502-505[DOI:10.3760/cma.j.issn.1004-4477.2016.06.010]
14杨洁,张学兰.超声造影与声辐射力脉冲成像技术在肝脏占位性病变鉴别诊断中的应用价值.中国超声医学杂志2015;31:518-520
15王强,闫军,冯晓彬,陈耿,夏锋,李晓武,马宽生,别平.补救性射频消融或门静脉栓塞术联合射频辅助肝脏分隔和门静脉结扎的二步肝切除术治疗肝硬化肝癌.中华消化外科杂志2016;15:455-460[DOI:10.3760/cma.j.issn.1673-9752.2016.05.011]