超声造影评价射频消融治疗肝癌局部疗效临床研究.docVIP

超声造影评价射频消融治疗肝癌局部疗效临床研究 　　[摘要] 目的 运用超声造影（CEUS）技术对肝癌射频消融（RFA）治疗前、后进行检测，探讨CEUS在评价RFA治疗肝癌局部疗效方面的临床价值。 方法 收集宜宾市第四人民医院2011年1月～2014年1月经确诊的原发性肝癌21例患者（21个病灶），继发性肝癌9例患者（20个病灶），共41个病灶进行超声引导下RFA治疗。观察RFA术前、术后即刻、术后1个月肿瘤CEUS检查情况。 结果 术前CEUS能较明确反映肿瘤实际大小以及肿瘤空间位置关系，帮助制订RFA治疗计划和预估治疗效果。术后即刻CEUS：29个肿瘤灭活完全，12个肿瘤有残留，随即进行补充治疗。术后1个月CEUS：6个（6/41）病灶周边可见动脉期结节状增强，门脉期消退的典型恶性肿瘤表现，提示肿瘤复发。同期增强CT（CECT）诊断有5个（5/41）肿瘤复发，CEUS与CECT诊断肿瘤复发率比较差异无统计学意义（P 0.05）。 结论 术前CEUS可反映肝癌实际需要治疗的范围大小及空间位置关系，能帮助临床制订RFA治疗计划。术后即刻CEUS检查，可以及时观察肿瘤有无残留以及残留部位的数目、大小等，对指导即刻RFA补充治疗具有重要临床意义。CEUS实时动态监测肝癌经RFA治疗后的局部疗效，能早期发现肿瘤局部病灶复发，对是否再次行RFA治疗具有一定的指导作用。CEUS与RFA治疗的结合将会是肝癌非手术介入治疗的一个新方向。 　　[关键词] 超声造影；肝癌；射频消融；超声检查 　　[中图分类号] R541.71 [文献标识码] A [文章编号] 1673-7210（2015）07（a）-0118-06 　　[Abstract] Objective To explore the clinical value of contrast-enhanced ultrasound （CEUS） in evaluating the local efficacy of radiofrequency ablation （RFA） in the treatment of a hepatic carcinoma， by using CEUS to examining it before and after RFA. Methods A total of 41 lesions， 21 cases of primary hepatic carcinoma（21 lesions）and 9 cases of secondary hepatic carcinoma（20 lesions）confirmed in the Fourth Peoples Hospital of Yibin City from January 2011 to January 2014 were treated by RFA under the guidance of ultrasound and the tumors were examined by CEUS before， immediately after and one month after RFA， respectively. Results Before RFA， the actual sizes and the spatial locations of the tumors were reflected relatively clearly by CEUS， which was helpful for making RFA plans and estimating the treatment efficacies. Immediately after RFA， the CEUS showed that， 29 tumors of the 41 tumors were inactivated completely with the rest 12 remaining residual， and then the supplementary treatments were added to them. One month after RFA， the nodular enhancements in the arterial phase， around 6 lesions of the 41 lesions were detected by CEUS， and in the portal phase retreat， it was apparent that they were typical malignant tumors， indicating their recurrences. In the corre