术中超声在肝脏恶性肿瘤切除手术中的临床应用研究

摘要

目的：探讨术中超声在肝脏恶性肿瘤切除术中的临床应用价值。方法选取术前行经腹超声及增强CT等检查，且术后病理证实为肝脏恶性肿瘤的患者48例，常规开腹后采用术中超声进行肿瘤定位并发现新的瘤病，统计术中超声对肝脏恶性肿瘤的检出率。比较术前经腹超声及增强CT与术中超声检查对肝脏恶性肿瘤诊断的敏感度和特异度。统计因术中超声检查结果而改变手术策略的病例。结果48例患者共发现69个病灶。其中肝细胞癌32例，胆管细胞癌11例，转移性肝癌5例。病理证实恶性肿瘤病灶56个，肿瘤大小平均3．65 cm （0．5～7．5 cm），其中有9个病灶直径≤1 cm，18个直径为1～2 cm，29个直径＞2 cm。统计结果显示，术中超声鉴别肿瘤良、恶性的敏感度和特异度均比术前经腹超声高（P＜0．05），但和CT比较差异无统计学意义。对于直径＜1 cm的肿瘤，术中超声的检出率明显高于术前CT和术前超声（ P＜0．05）。因术中超声检查结果而改变术前手术决策患者13例（27．1％）。结论术中超声能够发现术前影像学检查未能发现的微小病灶，与术前增强CT相比具有较高的敏感度和特异度，并通过检查结果帮助术者调整手术策略，在肝脏外科具有很好的临床应用价值。%Objective To evaluate the clinical application of intraoperative ultrasonography in the resection of ma -lignant liver tumor .Methods Forty-eight patients were selected in the current study .They underwent abdominal ultra-sound and enhanced CT examination before operation and were pathologically diagnosed with malignant liver tumor . Tumor localization and new tumor lesions were determined by intraoperative ultrasonography after conventional laparoto -my.The detection rate of malignant liver tumor by intraoperative ultrasonography was calculated .Meanwhile, preopera-tive transabdominal ultrasound , enhanced CT examination and intraoperative ultrasonography were compared for the sensi -tivity and specificity to diagnose malignant liver tumor .The cases where surgical strategies were adjusted due to intraoper-ative ultrasonography results were recorded .Results There were 69 foci in 48 patients, including 32 patients with hepa-tocellular carcinoma , 11 with bile duct cell carcinoma , and 5 with metastatic liver tumor .Fifty-six foci were proved pathologically malignant .The mean tumor size was 3.65 cm (0.5-7.5 cm).There were 9 foci with a diameter of <1 cm, 18 foci with a diameter of 1-2 cm, and 29 foci with a diameter of >2 cm.Intraoperative ultrasonography showed remarkably improved sensitivity and specificity for differentiating benign and malignant tumors , compared with preopera-tive abdominal ultrasonography (P<0.05) rather than enhanced CT examination .For tumors with a diameter of <1 cm, the detection rate of intraoperative ultrasonography was significantly higher than that of preoperative CT and preoperative ultrasonography (P<0.05).There were 13 patients (27.1%) whose surgical strategies were adjusted due to intraopera-tive ultrasonography results .Conclusion Intraoperative ultrasound is able to detect small foci that are otherwise unable to be found through preoperative imaging examination .Compared with preoperative enhanced CT , intraoperative ultra-sonography has improved sensitivity and specificity .This approach can facilitate the adjustment of surgical strategies , which can be applied for clinical practice .