超声造影评估微波消融治疗特殊部位原发性肝癌患者的价值

摘要/Abstract

摘要： 目的探讨应用超声造影评估微波消融治疗原发性肝癌(特殊部位)患者的疗效。方法 2020年6月—2022年6月南阳医学高等专科学校第一附属医院经病理学检查确诊的70例特殊部位原发性肝癌患者,根据治疗方法分为微波消融组(n=30)和微波消融联合无水乙醇组(n=40),开展回顾性研究。术后1个月行超声造影和增强CT检查,评估两组消融效果,并比较两组并发症发生率。结果超声造影检查发现微波消融组中完全消融22例,完全消融率为73.3 %,微波消融联合无水乙醇组中完全消融38例,完全消融率为95.0%,两种治疗方式完全消融率差异具有统计学意义(χ²=6.572, P=0.010);增强CT检查发现微波消融组中完全消融21例,完全消融率为70.0 %,微波消融联合无水乙醇组中完全消融36例,完全消融率为90.0 %,两种治疗方式完全消融率差异具有统计学意义(χ²=4.534, P=0.033);而超声造影、增强CT分别微波消融组、微波消融联合无水乙醇组时的完全消融率差异无明显统计学意义(χ²=0.082、0.721, P=0.774、0.396)。微波消融组中术后出血1例、感染1例、胆漏2例、腹腔积液2例、周围器官损伤1例,并发症总发生率为23.3 %(7/30);微波消融联合无水乙醇组中术后出血1例、感染2例、胆漏1例、腹腔积液4例、周围器官损伤1例,并发症总发生率为22.5 %(9/40)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论原发性肝癌(特殊部位)应用微波消融联合无水乙醇治疗成效显著,不仅能够提高肿瘤消融率,且不增加并发生风险。超声造影在消融效果评估中具有确切价值,与增强CT效能相当,可发挥临床指导作用。

关键词: 原发性肝癌, 特殊部位, 超声造影, 微波消融

Abstract: Objective To explore the application of contrast-enhanced ultrasound to evaluate the efficacy of microwave ablation for the treatment of special site primary liver cancer. Methods Between June 2020 and June 2022, 70 patients with primary liver cancer at special sites confirmed by pathological examination were divided into a microwave ablation group (n=30) and a microwave ablation combined with absolute alcohol group (n=40) according to the treatment method. A retrospective study was carried out in these two groups of patients. At one month after surgery, contrast-enhanced ultrasound and enhanced CT were performed to evaluate the ablation effect and compare the incidences of complications in them. Results By contrast-enhanced ultrasound it was shown that 22 cases were completely ablated in microwave ablation group, and the complete ablation rate was 73.3%, while 38 cases were completely ablated in microwave ablation combined with absolute ethanol group, and the complete ablation rate was 95.0%. The difference between the two treatment methods was statistically significant (χ²=6.572, P=0.010). By enhanced CT it was shown that 21 cases were completely ablated in microwave ablation group, and the complete ablation rate was 70.0%, while 36 cases were completely ablated in microwave ablation combined with absolute ethanol group, and the complete ablation rate was 90.0%. The difference between the two treatment methods was statistically significant (χ²=4.534, P=0.033). However, there was no significant difference in the complete ablation rate between contrast-enhanced ultrasound and enhanced CT in microwave ablation group and microwave ablation combined with absolute alcohol group (χ²=0.082, 0.721, P=0.774, 0.396). In the microwave ablation group, there was 1 case of postoperative bleeding, 1 case of infection, 2 cases of bile leakage, 2 cases of abdominal fluid accumulation, and 1 case of peripheral organ injury. The total incidence rate of these complications was 23.3% (7/30); In the microwave ablation combined with anhydrous ethanol group, there was 1 case of postoperative bleeding, 2 cases of infection, 1 case of bile leakage, 4 cases of abdominal fluid accumulation, and 1 case of peripheral organ damage. The total incidence rate of complications was 22.5% (9/40). There was no statistically significant difference in the total incidence of complications between the two groups (P>0.05). Conclusion The application of microwave ablation combined with anhydrous ethanol in the treatment of primary liver cancer at special sites has significant effects, which improves the tumor ablation rate without increasing recurrence risk. Contrast enhanced ultrasound has a definite value in evaluating the ablation effect, which is equivalent to the efficacy of enhanced CT and should play a guiding role in clinical practice.

Key words: Primary liver cancer, Special parts, Contrast-enhanced ultrasound, Microwave ablation

郝苑苑, 王君, 徐大超. 超声造影评估微波消融治疗特殊部位原发性肝癌患者的价值[J]. 肝脏, 2024, 29(5): 526-529.

HAO Yuan-yuan, WANG Jun, XU Da-chao. The value of contrast-enhanced ultrasound in evaluating microwave ablation therapy for patients with special site primary liver cancer[J]. Chinese Hepatolgy, 2024, 29(5): 526-529.

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