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。

Clinical value of contrast-enhanced ultrasonography immediately after radiofrequency ablation for malignant hepatic tumors

Objective: To investigate the clinical value of contrast-enhanced ultrasonography (CEUS) immediately after radiofrequency ablation (RFA) for malignant hepatic tumors. Methods: Sixty consecutive patients with malignant hepatic tumors (76 lesions) admitted between October 2014 and December 2015 in Xiangya Hospital were randomly designated to study group and control group with 30 cases in each group (41 lesions in study group, 35 lesions in control group). All patients underwent percutaneous RFA under real time ultrasound guidance. In patients in study group, CEUS was performed immediately (within 5-10 min) after RFA, and supplementary ablation was conducted immediately for the tumor residues until no residue was detected by contrast examination, while immediate CEUS was not performed in those in control group. Patients in study group underwent CEUS again at 36-48 h after RFA, and patients in both groups underwent CEUS together with contrast-enhanced CT or MRI as well as detection of liver function parameters and tumor markers at 1 month after the RFA. Results: A total of 5 tumor residues were found by immediate CEUS in 5 patients of study group , and supplementary treatments were performed. By review examinations for the two groups at 1 month after RFA, one tumor residual (1/41) was found in study group and 7 tumor residuals (7/35) were found in control group, and the complete ablation rates between study group and control group were statistically different (96.7% vs. 80.0%, P<0.05). In study group, the thickness of the hematoma or edema around the ablation zone detected by CEUS in arterial phase examination immediately after RFA and 36–48h later was (6.89±2.73) mm and (4.68±2.05) mm respectively, and the difference had statistically significant (P<0.05). Conclusion: CEUS immediately after RFA can timely detect the tumor residuals and direct supplementary therapy, and effectively increase the complete ablation rate.