术中超声造影在肾肿瘤射频消融中的应用

摘要

目的 探讨超声造影(CEUS)在肾肿瘤射频消融(RFA)术中疗效评估中的作用.方法 对107例肾肿瘤患者110个病灶行RFA治疗,肿瘤位于左肾49例,右肾55例,双肾3例.肿瘤最大径1.5～8.6 cm.治疗后常规采用18G活检穿刺针对肿瘤行穿刺活检2～4针,送病理检查.所有患者射频消融前、术中、术后行CEUS检查,观察造影剂在动脉相与实质相的灌注情况变化,评价病灶消融范围,如有残留病灶,当即补行RFA.术后1周、1个月、3个月、半年所有患者复查增强CT、CEUS,评价CEUS的诊断符合率.结果 107例110个病灶一次手术均消融完全(100％).术中CEUS提示首次RFA后5例患者原病灶有局部强化,立即补行RFA后行CEUS未提示强化.术后平均随访11(3～18)个月,CEUS、增强CT均提示所有病灶全部消融完全.患者均存活.结论 术中CEUS的应用,可提高射频消融术一次性成功率.%Objective To assess the intraoperative efficacy of contrast-enhanced ultrasonography (CEUS) in the radiofrequency ablation (RFA) of renal tumors.Methods RFA was performed on 110 renal tumors (size range:1.5-8.6 cm,49 located in the left,55 right and 3 bilateral) in 107 selected patients.Conventional tumor biopsy was conducted for pathological diagnosis using 18G biopsy needle after RFA.CEUS was performed in all patients before,during and after RFA to assess the necrotic area.Once suspicious residual lession was discovered by CEUS,another round of RFA was taken immediately.Initial follow-up enhanced CT and CEUS was performed seven days after the procedure,with subsequent CEUS and enhanced CT after one month,three months,and six months to assess the necrotic area.Technical success was defined as elimination of areas that enhanced at imaging within the entire tumor.Results With CEUS performed during RFA,110 tumors (100％) were successfully ablated during one operation.Of these,five tumors was subjected to additional RFA treatment for the suspicious residual lesion detected by CEUS right after initial RFA.Elimination of areas covered the entire tumor after the second RFA.No residual or recurrence tumors was confirmed by both enhanced CT and CEUS during follow-up.All patients survived in the follow-up phase which ranged from 3 to 18 months(mean 11 months).Conclusions With the application of intraoperative CEUS,there were less residual tumors after RFA.