CAJ | 학술논문

目的评价术中超声(IOUS)在原发性肝癌首次肝切除及再次肝切除中的有效性.方法对430例原发性肝癌、555次肝切除患者资料进行回顾性分析,观察IOUS在第一次和第二次肝切除中的作用,随访患者手术后的远期效果.结果在目前所用常规影像学检查中,IOUS的诊断率最高.在第二次肝切除手术中,各项影像学检查的诊断率都有轻度降低.在第一次肝切除手术组,IOUS在30例患者共发现56个新肿瘤(7.0％)；第二次肝切除手术组,IOUS在8例患者共发现13个新肿瘤(7.3％).第一次和第二次肝切除术手术中,肿瘤的平均直径分别为(8.7±3.8) mm和(9.0±5.2) mm.由于IOUS的缘故,第一次及第二次肝切除手术组中分别有24例(5.6％)和7例(6.4％)患者改变了手术方案.尽管第一次肝切除手术时IOUS发现新肿瘤的患者术后复发率较高,但术后经适当治疗,其远期效果与IOUS未发现新肿瘤的患者并无显著差异.结论尽管影像技术不断发展,但IOUS仍为目前最敏感的检查手段.在复发性肝癌行再次肝切除时,IOUS对于发现新的肿瘤同样重要.IOUS发现新肿瘤的患者术后极容易复发,术后定期随访对延长患者生存期非常重要.
목적 평개술중초성(IOUS)재원발성간암수차간절제급재차간절제중적유효성.방법 대430례원발성간암、555차간절제환자자료진행회고성분석,관찰IOUS재제일차화제이차간절제중적작용,수방환자수술후적원기효과.결과 재목전소용상규영상학검사중,IOUS적진단솔최고.재제이차간절제수술중,각항영상학검사적진단솔도유경도강저.재제일차간절제수술조,IOUS재30례환자공발현56개신종류(7.0％)；제이차간절제수술조,IOUS재8례환자공발현13개신종류(7.3％).제일차화제이차간절제술수술중,종류적평균직경분별위(8.7±3.8) mm화(9.0±5.2) mm.유우IOUS적연고,제일차급제이차간절제수술조중분별유24례(5.6％)화7례(6.4％)환자개변료수술방안.진관제일차간절제수술시IOUS발현신종류적환자술후복발솔교고,단술후경괄당치료,기원기효과여IOUS미발현신종류적환자병무현저차이.결론 진관영상기술불단발전,단IOUS잉위목전최민감적검사수단.재복발성간암행재차간절제시,IOUS대우발현신적종류동양중요.IOUS발현신종류적환자술후겁용역복발,술후정기수방대연장환자생존기비상중요.
Objective To evaluate the efficacy of intraopèrative ultrasonography (IOUS) on primary and repeated hepatectomies for hepatocellular carcinoma (HCC).Methods 430 patients underwent 555 operations for HCC.New tumors detected by IOUS at the primary and repeated hepatectomies were retrospectively analyzed.The long-term outcomes were also studied.Results IOUS had the highest sensitivity in the routinely used imaging examinations.The detection rate by each imaging modality decreased slightly but uniformly at the second hepatectomy.IOUS detected 56 new tumors in 30 patients (7.1％) at the primary hepatectomy and 13 new tumors in 8 (7.3％) at the second.The average size of tumor detected was 8.7±3.8 and 9.0±5.2 mm at the primary and second resections,respectively.The preoperative surgical plan was changed due to the IOUS findings alone in 24 patients (5.6％) at the primary hepatectomy,and in 7 (6.4％) at the second.Although recurrence was frequent in patients with new tumors detected at the primary hepatectomy,long-term survival after appropriate treatment for recurrence was similar to those patients without new tumors detected.Conlusions Despite recent progress in imaging modalities,IOUS is still the most sensitive examination.The same degree of precaution is necessary to detect new tumors using IOUS in repeated hepatectomy.Patients with new tumors detected by IOUS are at high risk for recurrence so that regular check-up is important to improve patient survival.