超声造影评价射频消融治疗肝转移瘤的近期疗效

摘要

Objective To investigate the value of contrast enhanced ultrasound(CEUS)in monitoring and evaluating the short term therapeutic response to radiof -requency ablation(RFA)of liver metastatic tumor. Methods 14 patients(31 liver metastatic tumors),who were neither appropriate candidates for resection,chemotherapy and radiotherapy nor willing to undergo resection, were treated with RFA. Of these,all patients' lesions were from digestive tract carcinomas confirmed by biopsy. The maximum lesion sizes ranged from 1.7～4.3 cm(mean,3.1 cm). 5 patients had single tumor lesion. The remaining 9 patients had multiple lesions. Each patient underwent CEUS within a week before RFA. Number,size, border, inner echo and perfusion pattern of lesions were observed. One month after ultrasoundguided RFA,color Doppler flow imaging,CEUS and biopsy(reference standard)were performed to assess the therapeutic response. Results 29 lesions were completely ablated according to the results of CEUS and biopsy 30 minutes and 1 month the RFA ( response rate,93.5％ ). There were 2 lesions with local recurrence which were treated with RFA again. In a follow-up program of 3-6 months,all patients were alive now. Conclusions It is feasible to ablate liver metastatic tumor using cool-RFA under CEUS guidance and monitoring. Ultrasound-guided RFA is an effective treratment option for liver metastatic tumor with low complication rates. It can be repeatedly used for intrahepatic recurrence and metastases and therefore has good prospect in treating liver metastases tumors.%目的 探讨超声造影引导和监控下行肝转移瘤射频消融(radiofrequency ablation,RFA)治疗,并观察其近期治疗效果及探讨射频消融临床应用价值.方法 对不宜手术、放疗、化疗或不愿接受手术治疗的肝转移瘤14例(31个病灶)行超声引导和监控下射频治疗.原发肿瘤均来自消化道.本组肿瘤最大径范围1.7-4.3cm(中位数,3.1cm),5例为单发灶,余9例为2-3个病灶.采用超声造影增强为主结合穿刺活检、肿瘤标记物等检查方法综合评价疗效.术前例行超声及其他影像学检查,确认肝转移瘤位置、大小、数目;所有病例经超声引导细针穿刺活检证实为转移瘤.结果 术后30 min及1个月后,超声造影声像图清晰显示29个病灶热消融灶呈无灌注区,病灶完全失去活性,近期有效率达93.5%.有2个病灶局部在术后1个月复发(超声造影显示局部增强),穿刺活检显示凝固性坏死不完全而行2次治疗.全部病例经3-6个月随访,目前患者全部存活.结论 超声造影引导和监控下射频消融术可作为肝转移瘤的一种微创局部治疗方法,其并发症少,缓解率高,是治疗肝转移瘤安全、有效的手段,其中超声造影监控是获得完全消融的关键,对评价肝转移瘤射频消融的近期疗效有重要应用价值.