超声造影在下腔静脉癌栓切除术中的应用

目的评估机器人辅助腹腔镜下腔静脉癌栓切除术中超声造影诊断癌栓是否侵犯静脉壁的临床价值。 方法回顾性分析解放军总医院第一医学中心2017年10月至2019年3月收治60例肾癌合并腔静脉癌栓患者的术中超声造影表现，观察、分析超声造影特征，与术中及术后病理结果相对照，以典型术中造影模式鉴别诊断癌栓是否侵犯静脉壁，诊断试验统计其敏感性、特异性、准确性、阳性预告值、阴性预告值。 结果60例腔静脉癌栓患者均接受了机器人辅助腹腔镜根治性肾切除联合下腔静脉内癌栓切除术。癌栓侵犯下腔静脉壁典型的超声造影表现为癌栓与下腔静脉壁同步高增强，下腔静脉壁连续性差，癌栓未侵犯下腔静脉壁典型的超声造影表现为癌栓与下腔静脉壁之间可见造影剂通过，下腔静脉壁连续性好。以典型增强模式判断癌栓侵犯腔静脉壁的敏感性、特异性、准确性、阳性预告值、阴性预告值为分别为93.1%、93.5%、93.3%、93.1%、93.5%。 结论术中超声造影在机器人辅助下腔静脉癌栓切除术中可以提供癌栓是否侵犯静脉壁重要信息，为手术方式的选择提供依据并可在术中及时给予术者实时信息，具有较高的临床应用价值。

Application of contrast-enhanced ultrasound in inferior vena cava thrombectomy

ObjectivesTo assess the value of intra-operative contrast-enhanced ultrasound(CEUS) in detecting wall invasion during robot-assisted inferior vena cava thrombectomy. MethodsThe intraoperative CEUS findings of 60 patients who were treated in first medical center, PLA General Hospital with renal tumors accompanied by IVC tumor thrombus were retrospectively analyzed between Oct. 2017 and Mar. 2019. The CEUS features were compared with the intra- and post-operative pathological findings. The IVC wall invasion was detected based on the typical CEUS findings. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS were statistically analyzed. ResultsCEUS in patients with wall invasion showed that the tumor thrombus was enhanced synchronously with the IVC wall, and the continuity of the IVC wall was poor. In contrast, in patients without wall invasion, CEUS showed that the contrast agent could pass between the tumor thrombus and the IVC wall and the continuity of IVC wall was good. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the typical enhancement mode of CEUS were 93.1%, 93.5%, 93.3%, 93.1%, and 93.5% in identifying wall invasion. ConclusionsIntraoperative CEUS in robot-assisted IVC thrombectomy is highly valuable in clinical application. It can provide important information about wall invasion, thus offering real-time information to the operator during surgery.