中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2013年
11期
907-912
,共6页
武金玉%林淑芝%陈敏华%吴薇%杨薇
武金玉%林淑芝%陳敏華%吳薇%楊薇
무금옥%림숙지%진민화%오미%양미
超声检查%造影剂%肝肿瘤%消融技术
超聲檢查%造影劑%肝腫瘤%消融技術
초성검사%조영제%간종류%소융기술
Ultrasonography%Contrast media%Liver neoplasms%Ablation techniques
目的：探讨超声造影（CEUS）评价经皮射频消融（RFA）阻断肝癌血供的效果以及指导RFA治疗的应用价值。方法选择2006年1月至2007年6月北京大学肿瘤医院就诊的71例肝癌患者共75个病灶，均为富血供肝癌，均因不宜行动脉栓塞化疗术（TACE）或TACE疗效不佳拟行RFA。所有患者均经超声引导下穿刺活检病理证实。71例患者随机分为经皮消融阻断荷瘤血管（PAA）+RFA组与单纯RFA组2组。PAA+RFA组38例患者共39个病灶，首先行CEUS确认肿瘤荷瘤血管及浸润范围，并在彩色多普勒超声引导下进行PAA；即刻行CEUS评估肿瘤区域灌注及荷瘤血管阻断程度，并指导沿肿瘤外周区域及血供区域行肿瘤整体消融。单纯RFA组33例患者共36个病灶，于常规超声引导下进行消融，按计算方案及定位模式治疗，先消融肿瘤深部或临近其他脏器区域。治疗后1、3、6个月对2组患者行增强CT评价疗效。应用t检验比较2组患者消融病灶个数差异，应用χ2检验比较2组患者治疗后1、6个月肿瘤病灶灭活率差异。结果 PAA+RFA组患者PAA后即刻CEUS显示31个病灶（79.5%，31/39）瘤内灌注缺失范围超过70%，其中13个病灶（33.3%，13/39）显示肿瘤整体灌注缺失呈边界清晰规整的“日全食”征；8个病灶（20.5%，8/39）灌注缺失范围达40%~70%。PAA+RFA组38例患者共39个病灶PAA前彩色多普勒超声检查示42支主荷瘤血管良好显示；PAA后即刻彩色多普勒血流成像显示35支（83.3%，35/42）荷瘤血管被阻断，3支（7.1%，3/42）血管血流信号明显减少。PAA+RFA组每个肿瘤平均消融（3.18±1.42）个球灶，较单纯RFA组每个肿瘤平均消融（4.32±1.56）个球灶少，且差异有统计学意义（t=2.524，P=0.015）。治疗后1个月PAA+RFA组肿瘤病灶灭活率为92.3%（36/39），高于单纯RFA组的66.7%（24/35），且差异有统计学意义（χ2=8.264，P=0.001）。结论 CEUS证实PAA可成功阻断或减少荷瘤血供，增大射频凝固坏死区，有效降低富血供大肿瘤RFA复发率；重视CEUS指导PAA下RFA治疗，可减少消融病灶数目，有较高的应用价值。
目的：探討超聲造影（CEUS）評價經皮射頻消融（RFA）阻斷肝癌血供的效果以及指導RFA治療的應用價值。方法選擇2006年1月至2007年6月北京大學腫瘤醫院就診的71例肝癌患者共75箇病竈，均為富血供肝癌，均因不宜行動脈栓塞化療術（TACE）或TACE療效不佳擬行RFA。所有患者均經超聲引導下穿刺活檢病理證實。71例患者隨機分為經皮消融阻斷荷瘤血管（PAA）+RFA組與單純RFA組2組。PAA+RFA組38例患者共39箇病竈，首先行CEUS確認腫瘤荷瘤血管及浸潤範圍，併在綵色多普勒超聲引導下進行PAA；即刻行CEUS評估腫瘤區域灌註及荷瘤血管阻斷程度，併指導沿腫瘤外週區域及血供區域行腫瘤整體消融。單純RFA組33例患者共36箇病竈，于常規超聲引導下進行消融，按計算方案及定位模式治療，先消融腫瘤深部或臨近其他髒器區域。治療後1、3、6箇月對2組患者行增彊CT評價療效。應用t檢驗比較2組患者消融病竈箇數差異，應用χ2檢驗比較2組患者治療後1、6箇月腫瘤病竈滅活率差異。結果 PAA+RFA組患者PAA後即刻CEUS顯示31箇病竈（79.5%，31/39）瘤內灌註缺失範圍超過70%，其中13箇病竈（33.3%，13/39）顯示腫瘤整體灌註缺失呈邊界清晰規整的“日全食”徵；8箇病竈（20.5%，8/39）灌註缺失範圍達40%~70%。PAA+RFA組38例患者共39箇病竈PAA前綵色多普勒超聲檢查示42支主荷瘤血管良好顯示；PAA後即刻綵色多普勒血流成像顯示35支（83.3%，35/42）荷瘤血管被阻斷，3支（7.1%，3/42）血管血流信號明顯減少。PAA+RFA組每箇腫瘤平均消融（3.18±1.42）箇毬竈，較單純RFA組每箇腫瘤平均消融（4.32±1.56）箇毬竈少，且差異有統計學意義（t=2.524，P=0.015）。治療後1箇月PAA+RFA組腫瘤病竈滅活率為92.3%（36/39），高于單純RFA組的66.7%（24/35），且差異有統計學意義（χ2=8.264，P=0.001）。結論 CEUS證實PAA可成功阻斷或減少荷瘤血供，增大射頻凝固壞死區，有效降低富血供大腫瘤RFA複髮率；重視CEUS指導PAA下RFA治療，可減少消融病竈數目，有較高的應用價值。
목적：탐토초성조영（CEUS）평개경피사빈소융（RFA）조단간암혈공적효과이급지도RFA치료적응용개치。방법선택2006년1월지2007년6월북경대학종류의원취진적71례간암환자공75개병조，균위부혈공간암，균인불의행동맥전새화료술（TACE）혹TACE료효불가의행RFA。소유환자균경초성인도하천자활검병리증실。71례환자수궤분위경피소융조단하류혈관（PAA）+RFA조여단순RFA조2조。PAA+RFA조38례환자공39개병조，수선행CEUS학인종류하류혈관급침윤범위，병재채색다보륵초성인도하진행PAA；즉각행CEUS평고종류구역관주급하류혈관조단정도，병지도연종류외주구역급혈공구역행종류정체소융。단순RFA조33례환자공36개병조，우상규초성인도하진행소융，안계산방안급정위모식치료，선소융종류심부혹림근기타장기구역。치료후1、3、6개월대2조환자행증강CT평개료효。응용t검험비교2조환자소융병조개수차이，응용χ2검험비교2조환자치료후1、6개월종류병조멸활솔차이。결과 PAA+RFA조환자PAA후즉각CEUS현시31개병조（79.5%，31/39）류내관주결실범위초과70%，기중13개병조（33.3%，13/39）현시종류정체관주결실정변계청석규정적“일전식”정；8개병조（20.5%，8/39）관주결실범위체40%~70%。PAA+RFA조38례환자공39개병조PAA전채색다보륵초성검사시42지주하류혈관량호현시；PAA후즉각채색다보륵혈류성상현시35지（83.3%，35/42）하류혈관피조단，3지（7.1%，3/42）혈관혈류신호명현감소。PAA+RFA조매개종류평균소융（3.18±1.42）개구조，교단순RFA조매개종류평균소융（4.32±1.56）개구조소，차차이유통계학의의（t=2.524，P=0.015）。치료후1개월PAA+RFA조종류병조멸활솔위92.3%（36/39），고우단순RFA조적66.7%（24/35），차차이유통계학의의（χ2=8.264，P=0.001）。결론 CEUS증실PAA가성공조단혹감소하류혈공，증대사빈응고배사구，유효강저부혈공대종류RFA복발솔；중시CEUS지도PAA하RFA치료，가감소소융병조수목，유교고적응용개치。
Objective To investigate the role of contrast enhanced ultrasound (CEUS) in evaluating and guiding radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) and its feeding vessels. Methods From January 2006 to June 2007, 71 patients with 75 hypervascular HCC in Peking University Cancer Hospital who underwent RFA were included in the study. The diagnosis was conifrmed by ultrasound guided biopsy for all patients. These patients were not suitable for transcatheter arterial chemoembolization (TACE) or had poor responds to TACE. They were divided into two groups, which included group percutaneous artery ablation (PAA) combining RFA and group RFA. There were 38 patients with 39 HCC in group PAA combining RFA and CEUS were used to identify the range of HCC inifltration. Firstly, PAA of the feeding vessels was conducted under the guidance of color doplor lfow imaging (CDFI). Then CEUS was performed to evaluate HCC perfusion after blocking the feeding vessels. Finally, the rest of the tumor was ablated by RFA. In group RFA, there were 33 patients with 36 HCC, who did not undertake PAA before RFA. Generally, the RFA was planned based on tumor size and location, and the ablation started with deep part of HCC or portion close to nearby organs. Contrast CT was used as a post-RFA imaging for follow-up at 1, 3 and 6 months post-RFA. T test was used to compare the difference in focal lesions number between two groups, andχ2 tests were used to compare the difference in necrosis rate between two groups after treatment. Results In group PAA combining RFA, post-PAA CEUS showed intratumor perfusion decreased more than 70%in 31 HCC (79.5%, 31/39). Of them, 13 HCC (33.3%, 13/39) showed complete perfusion defect with clear margin, called“solar eclipse sign”. The rest 8 HCC (20.5%, 8/39) showed 40%-70%of perfusion defect. In group PAA combining RFA, CDFI showed 35 (83.3%, 35/42) feeding vessels were blocked, and 3 vessels (7.1%, 3/42) showed signiifcant decreased lfow signal after PAA. There were average 3.18±1.42 ablations per HCC in group PAA combining RFA, and 4.32±1.56 in group RFA. The number of ablations per HCC in group PAA combining RFA was signiifcantly less than group RFA (t=2.524, P=0.015). The tumor necrosis rate at 1 month post-RFA in group PAA (92.3%, 36/39) combining RFA was signiifcantly higher than that of group RFA (66.7%, 24/35) (χ2=8.264, P=0.001). Conclusions With CEUS, PAA can effectively block the feeding vessels of HCC, enhance ablated necrosis in the tumor and signiifcantly increase necrosis rate post-RFA for large hypervascular HCC. CEUS-assisted PAA can improve efifciency of RFA with less ablation number and better result.
