超声造影在肝细胞肝癌射频治疗中的应用

目的探讨超声造影（CEUS）在肝细胞肝癌（HCC）射频消融（RFA）治疗中的应用价值。方法对接受RFA治疗的84例HCC患者共105个病灶,于治疗前、后行CEUS检查,与常规超声、增强CT比较,分析CEUS在治疗前、治疗后、随访中的作用。结果 RFA治疗前：CEUS清晰显示95.24%（100/105）病灶的边界,优于常规超声[47.62%（50/105）];CEUS测量病灶平均最大直径、面积较常规超声测值大,差异有统计学意义（P〈0.01）;CEUS对荷瘤动脉血管的显示率为60.95%（64/105）,高于彩色多普勒（25.71%）和增强CT（42.86%）。RFA治疗后：CEUS与增强CT评价疗效符合率为96.15%;3个病灶CEUS发现残留,CEUS引导下完成补充治疗。随访：CEUS评价RFA治疗后病灶残留或复发的敏感度、特异度和准确率分别为84.62%、95.40%和94.00%,与同期增强CT比较,差异无统计学意义（P〉0.05）。结论 RFA治疗HCC中,CEUS可有效辅助,具有重要价值。     

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

目的探讨应用CEUS评估多电极冷循环射频消融(RFA)治疗小肝癌后肿瘤灭活程度的价值。方法对49例小肝癌患者(63处病灶)RFA治疗前后分别进行常规超声、CEUS检查及增强CT检查,评估病灶完全消融及局部残留情况。结果 RFA治疗前,CEUS测量病灶最大径为(2.47±0.53)cm,常规超声测值为(2.12±0.57)cm,二者差异有统计学意义(t=-4.907,P0.05)。CEUS测量病灶面积为(6.50±1.26)cm2,常规超声测值为(5.43±1.06)cm2,差异有统计学意义(t=-6.867,P0.05)。CEUS与增强CT对病灶检出率差异无统计学意义(χ2=0.25,P0.05)。RFA治疗后,CEUS判断肿瘤完全灭活与局部残留情况与增强CT差异无统计学意义(χ2=0.50,P0.05)。结论 CEUS可用于评估小肝癌RFA治疗效果。     

超声引导下射频消融治疗肝转移瘤的疗效观察

目的评价超声引导下射频消融（RFA）治疗结直肠癌肝转移瘤（MLC）的疗效。方法采用超声引导下RFA治疗结直肠癌MLC患者60例134个病灶,其中91个病灶≤3.0 cm,43个〉3.0 cm。术前39例血清癌胚抗原（CEA）增高,21例正常。采用CEUS检查结合增强CT、穿刺活检及CEA值的动态变化综合评价肿瘤治疗效果。结果术后3个月复查CEA,37例增高,23例正常。术后30 min CEUS检查显示127个射频消融病灶呈无灌注区,近期有效率达94.78%（127/134）。术后1个月CEUS检查显示8个病灶局部增强,考虑复发,经超声引导下穿刺活检及细胞学检查证实而行第2次治疗。术后1个月增强CT复查显示126个（126/134,94.03%）射频消融病灶呈无灌注区,为完全坏死的转移病灶;部分坏死病灶为8个,与CEUS结果一致。结论超声引导下RFA是治疗MLC的一种安全有效的局部微创治疗方法。     

超声造影检查在肾肿瘤射频消融术后疗效评估中的应用价值

目的 探讨实时超声造影(CEUS)检查在肾肿瘤射频消融(RFA)术后疗效评估中的作用.方法 对47例肾肿瘤患者(肾癌40例,肾血管平滑肌脂肪瘤7例)49个病灶行RFA治疗,其中经腹腔镜下RFA 30例,开放手术RFA 17例.术后1周行常规超声及CEUS检查,观察造影剂在动脉相与实质相的灌注情况,评价病灶消融范围,并与增强CT结果比较.影像学上病灶无增强被认为是消融完全. 结果 49个病灶完全消融47个(95.9%).CEUS显示肾消融灶最大径为2.4～10.0 cm,平均(4.6±1.5)cm,其中消融灶大于原病灶者45个、与原病灶相同者3个、小于原病灶者1个.CEUS提示RFA术后原病灶有局部强化6例,其中2例经增强CT证实.以增强CT结果作为诊断标准,CEUS对RFA术后残留灶诊断的敏感性为100.0%,特异性为91.8%.术后平均随访11(4～21)个月,患者均存活. 结论 CEUS检查与CT结合对评价肾肿瘤RFA术后疗效具有实用价值.

Abstract：

Objective To discuss the utility of contrast-enhanced ultrasonography (CEUS) in the assessment of treatment efficacy of radiofrequency ablation (RFA) in patients with renal tumors.Methods Forty-seven patients (40 renal cell carcinomas and 7 angiomyolipomas of kidney) with 49 renal tumors were treated with RFA. Tumors were ablated by laparoscopy-assisted (n= 30) and open surgical (n= 17) RFA. The CEUS and contrast-enhanced CT were performed 1 week after treatment to assess the necrotic area. Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor. Results Forty-seven (95. 9%) of 49 tumors were successfully ablated. The mean length of the major axis at the maximal necrotic area was 4. 6 cm. Compared with the lesions before RFA, the necrotic areas were bigger in 45 patients, identical in 3 patients, and smaller in 1 patient. Six lesions showed a residual enhancement at the portion adjacent to the normal renal parenchyma on follow-up CEUS, while 2 were confirmed by CT scans. The sensitivity and specificity of CEUS for detection of residual tumors were 100. 0% and 91.8%, respectively. All patients survived in the follow-up period ranging from 4 to 21 months. Conclusion CEUS combined with CT could be useful for evaluating treatment efficacy of RFA for renal tumors.     

超声造影引导经皮穿刺射频消融治疗肝癌肝移植术后肝转移

目的通过临床总结,评价超声造影（CEUS）辅助射频消融（RFA）治疗肝癌肝移植术后肝转移的优点及应用价值。方法采用超声造影辅助定位经皮穿刺RFA治疗肝癌肝移植术后肝转移癌12例,直径1．2—5．5cm,发现病灶时间为肝移植术后3—12个月,每个病灶通过超声造影诊断定位进行RFA1—2次,术后通过超声造影及增强CT评价疗效。结果11例病灶术后两周复查全部消融,1例最大病灶有部分残余行再次RFA,1个月后复查无局部复发。结论超声造影辅助下经皮RFA治疗肝癌肝移植术后肝转移癌,定位准确,效果好,操作简便易行,微创无并发症,可作为肝移植术后肝转移癌的首选治疗。     

超声造影评价肝癌消融疗效的价值

目的探讨超声造影(contrast-enhanced ultrasound,CEUS)在肝癌消融疗效评价中的价值。方法 2008年5月~2016年10月,对46例肝癌(60个病灶)行微波消融治疗,1个月复查,均行彩色多普勒血流显像(color Doppler flow imaging,CDFI)、增强CT(contrast-enhanced CT,CECT)、CEUS检查,对任一检查阳性的病灶进行穿刺活检。结果 CECT检出阳性病灶12个,穿刺活检证实为肿瘤残留。CEUS检出其中的11个(漏诊率8.3%,1/12),CDFI检出CEUS阳性中的8个(漏诊率33.3%,4/12)。均无假阳性。结论 CEUS评价肝脏肿瘤消融疗效方法简单、结果可靠、无辐射,在肝脏肿瘤消融后随访、引导残留病灶活检和治疗中优势明显。     

经支气管动脉化疗栓塞联合射频消融术治疗>5 cm肺癌

目的探讨经支气管动脉化疗栓塞（TACE）联合射频消融术（RFA）对较大肺癌局部肿块的灭活作用。方法2008年5-11月我科共收治4例肺癌患者（肿瘤最大径均〉5 cm,最大肿瘤为10 cm×8 cm×8 cm）。所有肿瘤均经病理活检证实为低分化腺癌。4例患者中2例介入治疗前曾接受系统化疗＋靶向治疗（NP方案＋恩度）,2例曾接受普通化疗,均因无法耐受化疗反应转而寻求介入治疗。对4例患者均先经支气管动脉行病灶侧TACE,术后3～7天给予CT引导下RFA治疗,均于局麻联合静脉强化麻醉下完成。术后1个月增强CT扫描评价疗效,如有不同程度的肿瘤组织残留或复发征象则再次行TACE＋RFA治疗。所有患者均定期影像随访至本研究结束。结果4例患者均接受2次TACE＋RFA联合治疗,第1次联合治疗后1个月CT增强扫描示均有不同程度的肿瘤组织残留征象;第2次联合治疗后1个月CT增强扫描均未见残存肿瘤组织征象。经2次TACE＋RFA联合治疗后随访至本研究结束6～12个月,影像学随访示局部射频灶均有不同程度的缩小,未见残存或复发征象。结论TACE＋RFA联合治疗可以有效地灭活直径〉5 cm肺癌局部病灶,近期疗效较好,远期疗效有待于长期随访。     

肝脏恶性肿瘤射频消融术后即刻超声造影的临床价值

目的:探讨肝脏恶性肿瘤射频消融(RFA)后即刻超声造影(CEUS)的临床价值。方法:将中南大学湘雅医院收治的60例肝脏恶性肿瘤患者(76个病灶)随机分为试验组与对照组,每组30例(试验组41个病灶,对照组35个病灶)。两组均采用超声实时引导下经皮RFA治疗,试验组于RFA后即刻(5~10 min内)行CEUS,若发现肿瘤残存则行补充消融治疗,至造影检查无肿瘤残存时结束;对照组RFA后不做即刻CEUS。试验组患者术后36~48 h复查CEUS,所有患者术后1个月复查CEUS及增强CT或增强MRI、肝功能及肿瘤标志物。结果:试验组患者RFA术后即刻CEUS发现5例患者共5处病灶有残存,对残存肿瘤行补充治疗。两组患者1个月后复查,试验组发现1处病灶残存(1/41),对照组发现7处病灶残存(7/35),试验组与对照组的完全消融率差异有统计学意义(96.7%vs.80.0%,P0.05)。试验组患者RFA后即刻及36~48 h CEUS动脉期所测射频灶周围充血水肿带的宽度分别为(6.89±2.73)mm、(4.68±2.05)mm,差异有统计学意义(P0.05)。结论:肝脏恶性肿瘤RFA治疗后即刻CEUS能及时发现残存肿瘤并指导补充治疗,有效提高完全消融率。     

经导管动脉化疗栓塞联合射频消融治疗原发性肝癌

目的探讨经导管动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合CT引导下水循环冷却式射频消融(radiofrequency ablation,RFA)治疗原发性肝癌的临床疗效。方法 2011年10月~2014年8月对32例原发性肝癌41个病灶(直径3.0 cm病灶7个,3.0~4.0 cm 6个,4.0~5.0 cm 9个,5.0 cm 19个)采用TACE联合CT导向下水循环冷却式射频消融治疗,联合治疗后第1、3个月行螺旋CT双期增强扫描评价疗效。结果肿瘤影像学评价,完全缓解(complete remission,CR)11个,部分缓解(partial remission,PR)24个,稳定(no change,NC)5个,进展(progressive disease,PD)1个。32例随访10~22个月,31例存活,1例术后13个月因上消化道大出血死亡。结论 TACE联合CT引导下水循环冷却式RFA是治疗原发性肝癌安全、微创、有效的方法。     

一次定位多点穿刺法在射频消融治疗大肝癌中的应用

目的 探讨一次定位多点穿刺技术在射频消融(radio—frequency ablation，RFA)治疗大肝癌中的应用及疗效。方法 采用一次定位多点穿刺技术对53例大肝癌病人70个病灶进行RFA治疗；肿瘤直径平均6．9(5～lo)cm；治疗前后检查肝功、增强CT、彩超以肝穿活检；观察RFA治疗次数、治疗后的并发症以及肿瘤完全坏死率，并随访病人的生存情况。结果 53例病人的70个病灶共行RFA治疗81次，平均1．53次。RFA治疗后经6个月以上的增强CT复查，肿瘤完全坏死率为72．9％。53例中有12～18个月随访结果的48(90．5％)例，1年生存率为70．8％(35／48)。结论 一次定位多点穿刺法用于RFA治疗大肝癌是一种微创、安全且疗效显著的方法。     

Monitoring radiofrequency renal lesions in real time using contrast-enhanced ultrasonography: a porcine model

BACKGROUND AND PURPOSE: Ablation by cold (cryoablation) or radiofrequency energy (RFA), has been popularized for the treatment of small renal tumors. Regrettably, there currently is no reliable method of radiologically monitoring the propagation of RF lesions in real time. Ultrasonography enhanced by gas-filled microbubble contrast agents allows depiction of regions of tissue perfusion and has been described as a useful adjunct in diagnosing renal pseudotumors, improving prostate biopsy results, and confirming successful ablation of liver tumors. We hypothesized that contrast-enhanced ultrasonography (CEUS) would allow us to define, in real time, areas of cell death secondary to RFA and thus determine successful treatment. MATERIALS AND METHODS: Five female swine underwent initial laparoscopic exploration and creation of ipsilateral upper- and lower-pole renal RFA lesions. Lesion size was measured with standard gray-scale, Doppler, and microbubble CEUS. After 2 weeks, an identical procedure was performed on the contralateral kidney, including repeat sonographic measurements on the first kidney. All swine were then immediately sacrificed, and both kidneys (20 lesions) were harvested for pathologic analysis (hematoxylin-eosin and nicotinamide adenine dinucleotide stains). Radiographic lesion size was then compared with the gross and microscopic findings. RESULTS: The RFA lesions could not be imaged accurately in real time with standard gray-scale or Doppler sonography. However, microbubble CEUS was able to monitor parenchymal blood flow and, thus, the lesions (no blood flow) in real time. Hypoechoic lesions (no bubble enhancement) imaged during contrast sonography corresponded with regions of cell death as demonstrated on pathologic analysis. CONCLUSIONS: Microbubble CEUS is can monitor RFA lesions in real time. This novel imaging modality should allow more effective renal tumor ablation.     

超声引导下经皮射频消融治疗肝癌

目的观察超声引导下射频消融术(RFA)治疗肝癌(LC)的效果。方法回顾性分析165例LC,其中52例接受保守治疗(保守治疗组),55例(60个肿瘤)接受手术治疗(手术治疗组),58例(64个肿瘤)接受超声引导下射频消融治疗(RFA组),于治疗前后接受CEUS、CT或PET-CT、肝功能、甲胎蛋白(AFP)、癌胚抗原(CEA)等检查,并定期接受临床随访。结果 RFA组患者住院时间和费用明显低于保守治疗组和手术治疗组(P均<0.05);治疗后3个月有效率在手术治疗组与RFA组间差异无统计学意义(P>0.05),但明显高于保守治疗组(P<0.05);3组患者的肝功能指标、AFP、CEA均较治疗前明显下降(P均<0.05),手术治疗组与RFA组优于保守治疗组(P均<0.05);2年生存率在手术治疗组与RFA组间差异无统计学意义(P>0.05),但均明显高于保守治疗组(P均<0.05)。结论超声引导下射频消融治疗原发及转移性LC有效、安全、费用低,特别适用于不能耐受或者不愿手术且直径<5cm的肿瘤。     

小肝癌的射频消融治疗

目的： 总结射频消融(RFA)治疗肿瘤直径≤5cm小肝癌的疗效和经验。方法： 从1999年9月-2005年5月期间，采用RFA治疗肿瘤直径≤5cm的原发性或转移性肝癌共130例, 其中原发性肝癌86例，转移性肝癌44例。18例结合肝动脉栓塞化疗，20例同时行RFA联合瘤内无水酒精注射术。结果：1，3年总累积存活率分别为91.3%，77.7%。治疗中7例发生并发症，分别为少量胆瘘、肠瘘、轻度皮肤灼伤，未发现与治疗相关的死亡。结论：RFA对肿瘤直径≤5cm的小肝癌是一种相对安全、有效的治疗方法，并有可能达到与手术切除相似的效果。     

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??Current indications and efficacy of radiofrequency ablation in the treatment of liver cancer ZHANG Jie??CHEN Min-shan. Department of Hepatobiliary Surgery??Cancer Center??Sun Yat-sen University??Guangzhou 510060??China
Corresponding author??CHEN Min-shan??E-mail??cms64@163.com
Abstract Radiofrequency ablation (RFA) has been accepted as one of the curative therapies for small liver cancer, following liver resection and transplantation with its development and clinical application in liver cancer over 20 years. The published experts’ statement in China has confirmed the impartment role of RFA in the treatment of liver cancer and defined that RFA can be used as a curative treatment for single tumor ≤5 cm or tumor number ≤3 and each ≤3 cm, and as a palliative or combined treatment for unresectable single tumor >5 cm or multiple tumors >3 cm. Laparoscopic RFA is superior to percutaneous RFA for tumors in unfavorable location. RFA combined with disconnection is an effective treatment for patients with liver cancer and portal hypertension. Combined with transcatheter arterial chemoembolization (TACE), RFA can improve its ablative region, complete ablation rate and prognosis.     

超声造影在肝癌消融治疗中的作用

目的 探讨超声造影(CEUS)在肝癌消融治疗中对病例选择、疗效判断和引导穿刺的作用.方法 应用第二代超声造影剂声诺维2.4 ml经肘静脉团注、采用低机械指数连续成像技术对比脉冲序列(CPS)成像技术对137例肝癌病人(肝细胞性肝癌HCC 131例,转移性肝癌MLC 6例)共计168个肝癌灶消融前后进行CEUS检查,观察消融前造影前后肿瘤数目、大小、血供情况的变化,分析消融后CEUS在肿瘤诊断和疗效判断中的作用,并以同期CT或MRI或病理作为金标准进行比较.所有病例均取得病理诊断.结果 137例肝癌(微波消融MWA 80例、Quadra-Fuse多极酒精消融QEA 57例)的完全消融91.1%,不完全消融8.9%,局部复发8.3%,远处复发20.4%.造影前后肿瘤大小差异明显者4例(2.9%);造影后肿瘤数目增多者16例,减少者5例,平扫超声不能显示只能通过CEUS确认病灶8例,29例(21.2%)造影后与造影前比较肿瘤数目有改变,12例(8.8%)因肿瘤数目的 变化而改变了治疗方案.消融后平扫超声不能确定的局部残留灶15处和局部复发灶11处再消融前需要CEUS定位穿刺治疗.其中1处局部复发灶和1处残留灶CT未能检出,均由CEUS先诊断,并得到病理活检证实.CEUS与CT或MRI比较,对消融治疗后有无残留和局部复发判断的准确性达98.8%和98.8%.结论 消融前CEUS有助于正确选择消融病例和治疗方案、显示平扫超声无法显示的肿瘤.消融后CEUS能准确确定消融范围、判断消融疗效、能敏感的检出平扫超声未能检出的小残留灶和复发灶,并定位引导残留灶和复发灶的穿刺治疗.