术中超声在肝脏肿瘤手术中的应用价值

目的 探讨术中超声在肝脏肿瘤手术中的应用价值.方法 对45例肝脏肿瘤患者行术中超声检查(Logiq 500型超声仪,5～7.5 MHz线阵式术中专用探头),并与术前超声(PHILIPSHDI 5000型超声仪,3.5～5 MHz凸阵式探头)和增强CT检查对比分析,比较三者在病灶检出率方面的差异.结果 术中超声对直径≥1 cm病灶的检出率为100%,高于术前超声(89.80%)和CT(97.96%)的检出率,但差异无统计学意义(术前超声xc2=3.372,P>0.05,CT Fisher确切概率为P=1.00);术中超声对直径<1 cm病灶的检出率为90.70%,明显高于术前超声的检出率(62.79%)和CT检出率(74.42%)(术前超声x2=9.382,CT x2=3.957,均P<0.05);术中超声对病灶的总体检出率为95.65%,明显高于术前超声的检出率(77.17%)和CT检出率(86.96%)(术前超声x2=13.378,CT x2=4.381,均P<0.05),所有新发现的病灶都在术中超声的引导下行手术切除或无水乙醇瘤内注射.结论 与术前影像学检查相比,术中超声可以提高隐匿部位和微小病灶的检出率,有助于指导外科操作和手术治疗.

Intraoperative ultrasonography in the detection of liver tumors

Objective To evaluate intraoporative ultrasonography (IOUS) of liver tumors. Methods In this study, 45 patients with liver tumors were examined by the IOUS(Logiq 500 scanner with a dedicated 5 ～ 7.5 MHz linear-array intraoperative transducer), and the results of IOUS were compared with those of preoperative ultrasonography (PHILIPS HDI 5000 scanner with a 3.5 ～ 5 MHz convex-array transducer) and computed tomography (CT). Results For tumors with a diameter ≥ 1 cm, the detection rate of IOUS was 100%, which was higher than that of preoperative ultrasonography and CT (100% vs 89.80% and 97.96%), though there was no statistical significance(xc2 = 3.372 ,P >0.05 and Fisher exact probability was 1.00) ; For tumors with a diameter < 1 cm, IOUS had a significantly higher detection rate than preoperative uhrasonography and CT(90.70% vs 62.79% and 74.42%, respectively,the former x2= 9.382, the latter x2 = 3.957, both P < 0.05) ;The total detection rate of IOUS was significantly higher than that of preoperative ultrasonography and CT (95.65% vs 77.17% and 86. 96%, respectively, the former x2 = 13.378, the latter x2 = 4.381, both P < 0.05). All the detected lesions underwent surgical resection or intratumoral injection of ethanol with the guidance of IOUS. Conclusions Compared with preoperative imaging examination, IOUS not only can enhance the detection rates of preoperatively overlooked lesions, but also can provide more valuable information to guide the surgical procedures.