超声介入射频消融治疗肝脏肿瘤临床效果观察

黄剑毅　王瑶　曾曦　赵海燕

[摘要] 目的 探讨CEUS在原发性肝癌射频消融治疗中的应用价值。 方法 对2011年8月～2015年8月在我院消化内科住院治疗的132例原发性肝癌患者进行临床试验，随机将患者分成三组，其中41例为超声介导下RFA，44例为CT介导下RFA，47例为超声联合CT介导下RFA，比较三组肿瘤病灶的灭活及复发情况。 结果 超声介导组有10例存在残存，CT介导组有11例残存，组间差异无统计学意义（P>0.05）；联合介导组有4例存在病灶残留，明显低于另外两组，差异有统计学意义（P<0.05）。复查发现新发肿瘤病灶的患者中，超声介导组有7例，CT介导组有6例，两者比较差异无统计学意义（P>0.05）；而联合介导组仅1例复发，复发率较另外两组低且差异有统计学意义（P<0.05）。 结论 CEUS在RFA治疗中与CECT一样，能较灵敏地检测出肿瘤病灶；但与CECT联合应用后能弥补CT介导的缺点，提高肝内肿瘤病灶的检出率，减少病灶残留和新发的概率，有较高的临床应用价值。

[关键词] 超声；射频消融；原发性肝癌

[中图分类号] R735.7 [文献标识码] B [文章编号] 2095-0616（2015）24-111-03

[Abstract] Objective To study the application value of CEUS of radiofrequency ablation in the treatment of primary liver cancer. Methods 132 patients with primary liver cancer， who were hospitalization in gastroenterology department of our hospital from August 2011 to August 2015， were selected to make clinical trial and were divided into three groups， thereinto， 41 cases were treated with ultrasound-mediated RFA， 44 cases were treated with CT-mediated RFA， 47 cases were treated ultrasound combined CT-mediated RFA. To compare the condition of inactivated and recurrence of tumor focus among the three groups. Results There were tumor residue of 10 cases in ultrasound-mediated group and 11 cases in CT-mediated group， the differences between the two groups was no statistical significance（P>0.05）， while there were 4 cases in combined-mediated group， which was obviously lower than which in the other two groups， the differences was statically significant（P<0.05）. Reexamination discovered patients' new appeared tumor focus， there were 7 cases in ultrasound-mediated group， 6 cases in CT-mediated group， the differences between the two groups was no statistical significance（P>0.05）， while there was 1 case in combined-mediated group， the recurrence rate was lower than which in the other two groups， the differences was statically significant（P<0.05）. Conclusion CEUS in the treatment of RFA has the same sensitivity to detect the tumor focus with CECT. But CEUS combined CEUS could make up the disadvantages of CT-mediated， could improve the detection rate of intrahepatic tumor focus， could reduce the tumor residue and the new appeared probability， with higher clinical application value.

[Key words] Ultrasonic； Radiofrequency ablation； Primary liver cancer

原发性肝癌是指由肝细胞或肝内胆管上皮细胞发生的恶性肿瘤，是我国常见的恶性肿瘤之一[1]。射频消融（radiofrequency ablation，RFA）是肝癌中较新的治疗方式，也是非手术治疗的常用方法。对比增强CT（contrast-enhanced computed tomography ，CECT）被认为是评价RFA疗效的最有效方法[2]；而对比增强超声检查（contrast-enhanced ultrasonography，CEUS）也依靠它独有的特点，越来越广泛应用于临床[3]。为探讨CEUS在原发性肝癌射频消融治疗中的应用价值，进行了临床研究，现报道如下。endprint

1 资料与方法

1.1 一般资料

对2011年8月～2015年8月在我院消化内科住院治疗的132例原发性肝癌患者进行临床试验，随机将患者分成三组，其中41例为超声介导下RFA，44例为CT介导下RFA，47例为超声联合CT介导下RFA。本次选取进行RFA治疗患者的主要适应症[4]为：（1）单发肿瘤，最大径或肿瘤数≤5cm；或肿瘤数目≤3个，且最大直径≤3cm；（2）无血管、胆管和邻近器官侵犯以及远处转移；（3……