肝癌血供灌注特征与个体化介入治疗相关性的超声造影研究

摘要

目的 探讨不同类型肝癌的血供特点及确立个体化介入治疗模式的价值.方法 对315例经病理证实的肝癌应用彩色多普勒超声(CDUS)及超声造影(CEUS)行血供灌注特征分析并分型,采用不同介入治疗技术建立合理有效的个体化联合治疗模式,并采用CEUS、增强CT(CECT)、数字减影血管造影(DSA)进行疗效评估.结果 CDUS及CEUS可判定肝癌血供特征并分型.根据CDUS及CEUS确定的肝癌血供特征建立个体化介入治疗模式并评估疗效:①肿瘤直径≤3 cm单发小肝癌组,直接行无水酒精瘤内注射术(PEI)、射频消融术(RF)或微波消融术(PMCT)治疗模式,肿瘤坏死率95.0%～97.9%,1、3年生存率分别为98.0%、87.8%.②肿瘤直径≤5 cm病灶≤3个肝癌组,行多点、多面RF/PMCT+PEI联合治疗模式,肿瘤坏死率93.7%～94.8%,1、3年生存率分别为89.8%、81.4%.③肿瘤直径＞5 cm以肝动脉为主多血供肝癌组,行肝动脉栓塞化疗术(TACE)+PEI+RF/PMCT联合治疗模式,肿瘤坏死率71.4%～73.8%,1、3年生存率分别为66.2%、47.6%.④肿瘤直径＞5 cm双重血供肝癌或合并门静脉癌栓组,在以上治疗基础上增加选择性门静脉栓塞化疗术(SPVE)治疗模式,肿瘤坏死率53.3%～55.6%,1、3年生存率分别为64.7%、40.0%.结论 根据CDUS和CEUS确定肝癌血供特征并建立个体化联合介入治疗模式,对非手术治疗肝癌具有重要的临床价值.%Objective To identify the blood perfusion characteristics of different kinds of liver cancer and individualize interventional treatment models by color Doppler ultrasound(CDUS) and contrast-enhanced ultrasonography (CEUS). Methods The blood perfusion characteristics of 315 patients with liver cancer comfirmed by pathology were analyzed and classified using CDUS and CEUS. Individual interventional therapy models were selected based on the classification. Therapeutic effects were evaluated by EUS,contrast-enhanced CT(CECT) and DSA simultaneously. Results Liver cancer can be classified by the blood perfusion characteristics from CEUS examination. The individualized interventional treatment models were selected and evaluated according to the characteristics:①Solitary small HCC of diameter ≤3 cm group were treated via percutaneous ethanol injection(PEI),radiofrequency(RF) or percutaneous microwave coagulation therapy(PMCT). Necrosis rates of the lesions were 95.0% - 97.9%, 1 and 3 years survival rates were 98.0% and 87.8% ,respectively. ②Diameter ≤5 cm and lesions ≤3 group were treated with RF or PMCT combined PEI. Necrosis rates of the lesions were 93.7% - 94.8% ,1 and 3 years survival rates were 89.8% and 81.4% ,respectively. ③Diameter ＞5 cm and hypervascular tumor main fed by the hepatic artery group were treated with TACE,PEI combined RF or PMCT. Necrosis rates of the lesions were 71.4% - 73.8%, 1 and 3 years survival rates were 66.2% and 47.6%, respectively. ④ Diameter ＞5 cm and hypervascular tumor fed by double blood supply or accompanied by portal vein tumor thrombus group were treated with selective portal vein embolization(SPVE) based on the above treatments. Necrosis rates of the lesions were 53.3% - 55.6%, 1 and 3 years survival rates were 64.7% and 40.0%, respectively. Conclusions Classifying the blood perfusion characteristics and choosing individualized interventional treatment models by CEUS are of important clinical significance in non-surgical treatment of liver cancer.