肝转移癌射频消融治疗方案制定--超声造影的应用价值

摘要

Objective To assess the value of contrast-enhanced ultrasonography (CEUS) before percutaneous radiofrequency ablation (RFA) in treating patients with liver metastases. Methods A total of 267 patients with 485 liver metastatic lesions were treated with percutaneous RFA in authors ’ department during the period from July 2001 to December 2012. Among them , 180 patients with 251 lesions received CEUS examination before RFA and based on CEUS findings the treatment scheme was made (CEUS group), and other 87 patients with 234 lesions without use of preoperative CEUS were used as control group. No significant differences in clinical data existed between the two groups (P<0.05). Contrast-enhanced CT/MRI, CEUS and laboratory tests were regularly employed to evaluate the clinical results after RFA therapy. Results In CEUS group, 25.1% of the lesions (63/251) determined by CEUS were 3 mm larger than that determined by conventional US. 8.8%of the lesions (22/251) were more clear on CEUS findings. In addition, 41 new lesions were detected only on CEUS. No significant differences in early tumor necrosis rate existed between the two groups: 95.2%(239/251) vs. 92.7%(217/234)(P>0.05). The local recurrence rate of CEUS group was lower than that of the control group: 12.4% (46/234) vs. 19.7%(31/251) (P < 0.05). No significant differences in the recurrence time existed between the two groups (P > 0.05). Conclusion CEUS performed before RFA treatment for patients with liver metastases is very useful for accurately judging the size and number of the lesions, which is very helpful in making therapeutic scheme. Therefore, preoperative CEUS can significantly increase early tumor necrosis rate and decrease the local recurrence rate.%目的：探讨超声造影（CEUS）在肝转移癌经皮射频消融（RFA）治疗前的应用价值。方法2001年7月-2012年12月期间经皮RFA治疗的肝转移癌共267例485灶为本研究对象。其中180例251灶RFA治疗前行CEUS检查并确定RFA治疗方案（CEUS组），另87例234灶为RFA治疗前未行CEUS检查（对照组）。两组病例的各项临床资料差异均无统计学意义（P<0.05）。治疗后采用增强CT或（和）MRI、CEUS及肿瘤标志物检查定期随访判断疗效。结果 CEUS组中，25.1%（63/251灶）的CEUS测值较常规超声增大3 mm以上；8.8%（22/251灶）CEUS后显示清晰；造影后发现新病灶41灶。 RFA治疗后，肿瘤早期灭活率CEUS 组与对照组分别为95.2%（239/251灶）、92.7%（217/234灶），差异无统计学意义（P >0.05）。局部复发率CEUS组低于对照组，分别为12.4%（31/251）、19.7%（46/234）（P<0.05）。局部复发时间CEUS组与对照组差异无统计学意义（P>0.05）。结论肝转移癌经皮RFA治疗前行CEUS检查有助于准确判断病灶大小及数目，制订有效治疗方案，从而提高肿瘤早期灭活率、降低复发新生率。