超声造影在微波消融乳腺结节疗效评估中的临床应用#br#

［摘要］ 目的探讨超声造影在乳腺良性结节微波消融术中及术后疗效评估中的应用价值。 方法对30例患者43个乳腺良性结节行超声引导下微波消融治疗，术前采用二维超声和超声造影测定病灶位置、数目、体积，观察结节内的血流分布及强度，确定需消融范围，微波消融术后即刻行静脉超声造影检查，观察结节内造影剂增强情况，并根据增强体积将病灶分为1.5~3.5 cm3 、＞3.5~5 cm3和 ＞5 cm3 3组，计算各组病灶消融率，评估消融效果，对消融不彻底的残存病灶行补充治疗。术后1、6、12 个月采用二维超声和超声造影对患者进行随访，观察结节内有无造影剂灌注，测定结节体积及体积缩小率，进行消融术后的疗效评估。 结果消融术前二维超声和超声造影在全部 43 个乳腺结节内部及边缘均检出血流信号;微波消融结束后15 min，增强体积为1.5~3.5 cm3 、＞3.5~5 cm3 和＞5 cm3 3组病灶的消融率分别为97.45%、89.99%、67.05%，差异有统计学意义（P＜0.01），且超声造影显示8个结节边缘仍有少量不规则的造影剂灌注的残余组织，一次消融成功率为81.4%，针对存在的消融不完全区域行补充消融治疗。微波消融前、术后1、 6、12 个月乳腺结节体积比较差异有统计学意义（P＜0.01），术后1、 6、12 个月体积缩小率分别为44.1%、58.5%、72.3%，差异有统计学意义（P＜0.01）；消融术后1、 6、12 个月临床疗效和总有效率（72.09%、93.02%、100%）差异均有统计学意义（P＜0.01）。 结论超声造影在微波消融术前更能精准确定病灶位置及血流分布，术后对消融效果进行准确评价，以便对消融不完全区域及时行补充治疗，术后随访能及时准确发现残余病灶有无复发，达到乳腺结节完全消融的目的。

Clinical application of contrast-enhanced ultrasound in evaluating the therapeutic effect of microwave ablation for breast nodules

［Abstract］Objective〖HTSS〗To explore the applied value of contrast-enhanced ultrasound in evaluating the therapeutic effect during and after microwave ablation for breast nodules. 〖WTHZ〗Methods〖HTSS〗The 43 breast nodules of 30 patients admitted in our hospital were underwent Ultrasound-guided microwave ablation treatment. Before and after microwave ablation operation, two-dimensional ultrasound and contrast-enhanced ultrasound were used to measured the location, number and volume of nodules, observed the distribution and intensity of blood flow in nodules and determined ablation range. Intravenous contrast-enhanced ultrasound detection was carried out immediately after microwave ablation to observe the enhancement state of contrast agent in nodules. The nodules were divided into 3 groups: 1.5-3.5 cm3, ＞3.5-5 cm3 and more than 5 cm3 according to the enhanced volume, to calculate the ablation rate of lesions of each group and evaluate the ablation effect. Supplementary treatment for residual lesions which were incomplete ablation was carried out. The patients were followed up by two-dimensional ultrasound and contrast-enhanced ultrasound after 1, 6 and 12 months of ablation, observed whether there were contrast agent perfusion in nodules and measured the volume and volume reduction rate of nodules. The evaluation of curative effect was also carried out. 〖WTHZ〗Results〖HTSS〗Two-dimensional ultrasound and contrast-enhanced ultrasound both detected blood flow signals in all 43 breast nodules. 15 minutes after microwave ablation, the ablation rates of lesions with enhanced volume of 1.5-3.5 cm3, ＞3.5-5 cm3 and more than 5 cm3 were 97.45%, 89.99% and 67.05% respectively，there was significant statistical difference（P＜0.01）. Contrast-enhanced ultrasound showed there were 8 residual tissue which had a small amount of irregular contrast medium perfusion at the edge of nodules. The successful rate of primary ablation was 81.4%. Supplementary ablation treatment for residual incomplete ablation areas was carried out. There was significant statistical difference among the volume of breast nodulesbefore and after 1, 6 and 12 months of microwave ablation operation(P＜0.01).The volume reduction rates were 44.1%, 58.5% and 72.3% respectively, there was significant statistical difference（P＜0.01）.There were significant differences in clinical efficacy and total effective rate(72.09%, 93.02%,100%) after 1, 6 and 12 months of microwave ablation operation(P＜0.01). 〖WTHZ〗Conclusion〖HTSS〗Contrast-enhanced ultrasound can more accurately determine the location and blood flow distribution of the lesion before microwave ablation and accurately evaluate the ablation effect after ablation operation, so timely supplementary treatment can be provided for incomplete ablation areas. Postoperative follow-up can timely and accurately detect whether residual lesions reappeared again and achieve the complete ablation of breast nodules.