超声造影评价微波凝固治疗肝细胞肝癌的应用

目的：探讨超声造影在评价微波凝固治疗肝细胞癌（HCC）的应用价值。方法：经静脉注射造影剂SonoVue后,对30例（男20例、女10例）HCC患者（共33个病灶）在低机械指数状态下进行实时超声造影检查,评价微波治疗疗效,所有病灶微波治疗后半小时至2周采用超声造影检查评价疗效,并与同期增强CT检查结果进行比较,12个病灶治疗区取病理标本送检,21个病灶治疗区接受随访观察。结果：微波治疗后超声造影显示22个治疗区内部各期均无异常增强区,提示肿瘤完全灭活;11个治疗区边缘局部有早期结节状增强,判断有肿瘤残存;经穿刺活检及6个月以上的随访,证实微波治疗联合肝动脉栓塞化疗（TACE）,的2个HCC病灶,增强CT判断失误,增强CT诊断肿瘤灭活准确率为94%（31/33）;超声造影诊断肿瘤灭活准确率为97%（32/33）。统计结果显示,两者诊断肿瘤灭活差异无统计学意义（P〉0.05）。结论：超声造影不仅能评价HCC微波治疗的疗效,且能有效地评价TAE和微波凝固联合治疗HCC的疗效,因不受碘油干扰可优于增强CT。

Contrast enhanced ultrasound in evaluating the therapeutic effects of microwave coagulation on hepatic cellular cancer

Objective：To investigate the role of contrast enhanced ultrasound （CEUS） in evaluating the therapeutic effects of microwave coagulation on hepatic cellular cancer. Methods： Thirty patients （20 men, 10 women） with 33 tumors, which were confirmed by pathological findings, were examined by CEUS at low MI （0.05 -0.08 ） after intravenous injection of SonoVue, 0.5 hour and 2 weeks after microwave coagulation to evaluate the therapeutic effect. The results were recorded and compared with those from enhanced CT. Twelve therapy areas which were diagnosed as tumor residual with CEUS or enhanced CT were examined by biopsy pathology,and the 18 left areas were followed up for a period of more than six months. Results ： Twenty - two lesions after microwave coagulation examined with CEUS showed complete necrosis. The other eleven lesions which showed early - stage marginal local enhancement were diagnosed as tumor residua. According to biopsy pathology at more than 6 months of follow - up, two lesions under the combination -therapy with microwave coagulation and TACE were misdiagnosed with enhanced CT. The accuracy of enhanced CT and CEUS was 94% （31/33 ） and 97% （32/33）, respectively, and the difference was not statistically significant （P 〉 0.05 ）. Conclusion. Contrast enhanced ultrasound can not only help to assess the therapeutic effect of microwave coagulation on HCC but can effectively assess the effect of microwave coagulation combined with TACE. And the latter effect may be superior to that of enhanced CT, for the evaluating effect of CEUS is not influenced by retention of iodized oil.