超声造影在肝癌再次或多次射频消融中的应用

目的通过对原发性肝癌（HCC）患者病灶再次及多次进行冷循环射频消融（CRFA）前后超声造影（CEUS）的观察，探讨超声造影方法评估治疗疗效。方法58例HCC患者均已经接受CRFA治疗1次，在第一次CRFA结束后10min、每隔2周～1月经增强CT（CECT）或CEUS证实局部有残留病灶；在CEUS的监测下，再次或多次进行射频消融治疗。结果58位HCC患者共进行CRFA治疗245次（第一次治疗共58次），平均（34-1．78）次；第一组：病灶直径〈3cm，11例共18个病灶；第二组：病灶直径3—5cm；42例共53个病灶；第三组：病灶直径〉5cm，最大直径10．2cm，5例共9个病灶；第一组全部再次或多次进行了CRFA治疗；而第二、三组则是进行了CRFA＋TACE或PEIT联合治疗；随着时间的推移，肝脏出现多发病灶、门静脉癌栓的几率增加，且与原癌灶的直径有相关性，P〈0．05。第一组与后两组的1、2、3年生存率存在着差异，P〈0．001。结论CEUS可以动态显示靶区的微循环特点、残存病灶的形态及门静脉癌栓的形态特点，在选择治疗方式方面具有重要的指导意义。

To evaluate the effect using contrast-enhanced ultrasound in repeated cooled percutaneous radio frequency ablation for HCC

Objective To evaluate the efficacy of CEUS(contrast enhanced ultrasonography)in accessing the repeated curative effects of cooled radiofrequency therapy for hepacellular carcinoma(HCC).Methods 58 cases of residual lesion of HCC which had been treated with CRFA once received repeated CRFA treatment by the guidence of CEUS 10 minutes,every 2 weeks to 1 month after first CRFA.All these patients recruited for CECT and CEUS and residual lesions were verified.Results 58 cases received 245 CRFA treatment.mean of repeated CRFA(3±1.78)times.In group 1,there were 11 eases with 18 lesions,the diameter of lesion <3 cm.In group 2,42 cases with 53 lesions which the diameter were between 3 cm to 5 cm.In group 3,5 cases with 9 lesions of which the biggest diameter was 10.2 cm.all of the lesions's diameter were>5 cm.The cases of group 1 were treated with CRFA only,while the other groups were treated with combined therapies,ie:CRFA +TACE or PEIT.The appearance of multiple lesions and portal venous carcinomous emblia increased as time went by which correlated with the size of primary lesions,P<0.05.The 1,2,3 year-survival rates of group 1 differed significant from the other two groups,P<0.001.Conclusion CEUS Can dynamically show the characteristics of microcirculation,the contours of residual lesions,the portal venous emblia which can play an important role in selecting modalities of therapy to treat.