本文選題：轉(zhuǎn)移性肝癌 + 射頻消融術(shù)�。� 參考：《浙江大學(xué)》2014年碩士論文

【摘要】：背景和目的： 肝臟是惡性腫瘤的常見轉(zhuǎn)移部位,轉(zhuǎn)移性肝癌的治療效果直接影響患者的生存質(zhì)量及生存期,其治療仍是腫瘤治療中的難題。轉(zhuǎn)移性肝癌的預(yù)后取決于原發(fā)腫瘤的部位、肝臟受累范圍及患者的全身情況等,1年生存率不到50%。所以,選擇合適的治療方案,盡量延長(zhǎng)患者的有效生存期,是目前醫(yī)學(xué)的挑戰(zhàn)。 隨著醫(yī)學(xué)的發(fā)展,出現(xiàn)了除了手術(shù)治療以外的有效非手術(shù)治療手段,包括射頻消融術(shù)、肝動(dòng)脈栓塞化療、免疫治療等,效果已被肯定,同時(shí)也存在難題,就是術(shù)后治療滅活程度的評(píng)估,滅活不徹底的病灶需要及時(shí)進(jìn)一步處理。因此,各種非手術(shù)治療手段對(duì)于影像學(xué)技術(shù)的依賴性較高。近年來(lái),部分學(xué)者已對(duì)各種影像學(xué)檢查方式對(duì)于肝癌RFA術(shù)后效果的評(píng)價(jià)進(jìn)行了探討,包括超聲造影(CEUS)、計(jì)算機(jī)斷層掃描(CT)、磁共振掃描(MRI)等。其中,MRI檢查具有成本高、速度較慢的特點(diǎn),而CT輻射較為嚴(yán)重,CEUS對(duì)于操作者依賴度高。所以,需要在肝癌RFA術(shù)后綜合各種檢查手段,及時(shí)發(fā)現(xiàn)與處理殘留與復(fù)發(fā)病灶。 科技發(fā)展日新月異,MRI技術(shù)不斷發(fā)展,如磁共振彌散成像(DWI)在腹部疾病診斷的應(yīng)用,使得解決以上難題的道路上積累了更多經(jīng)驗(yàn)。DWI是一種對(duì)水分子擴(kuò)散運(yùn)動(dòng)敏感的成像技術(shù),在常規(guī)自旋回波的T2掃描序列中加入對(duì)稱的擴(kuò)散敏感梯度脈沖(b值),使在施加梯度場(chǎng)方向上的水分子運(yùn)動(dòng)活躍,相位離散加劇,信號(hào)減低,b值越大,水分子的離相越重,信號(hào)降低越明顯。通過(guò)b值可以計(jì)算出各種組織的表觀彌散系數(shù)(ADC)。如果組織有病變,則其信號(hào)降低的程度有差別,從而通過(guò)ADC值發(fā)現(xiàn)病變。DWI目前在腦部的應(yīng)用較為成熟,特別是對(duì)急性腦梗的診斷,但在腹部和其他臟器的應(yīng)用尚處于探索階段。 近幾年肝臟DWI的研究較多,包括肝癌TACE與RFA術(shù)后效果的評(píng)估。但是尚未有對(duì)于轉(zhuǎn)移性肝癌RFA術(shù)后殘留的研究。本研究旨在通過(guò)轉(zhuǎn)移性肝癌RFA術(shù)后病灶不同區(qū)域ADC值的變化,探討早期發(fā)現(xiàn)殘留結(jié)節(jié)的可能性。 方法： 在我院行RFA治療的轉(zhuǎn)移性肝癌患者,在RFA術(shù)前(1個(gè)月)及術(shù)后7天、1個(gè)月及3個(gè)月分別進(jìn)行磁共振掃描檢查及超聲造影檢查。掃描后通過(guò)掃描儀自帶軟件產(chǎn)生ADC圖,由2名經(jīng)驗(yàn)豐富的磁共振診斷醫(yī)師進(jìn)行ADC值的測(cè)量(包括正常肝組織、中心完全消融區(qū)域及可疑殘留區(qū)域),測(cè)量3次取平均值。由2名有經(jīng)驗(yàn)的超聲醫(yī)師對(duì)各個(gè)結(jié)節(jié)的超聲造影信息進(jìn)行分析及診斷,判斷有無(wú)殘留及復(fù)發(fā),意見不一致則討論后達(dá)成診斷。計(jì)量資料用mean±SD表示,對(duì)不同區(qū)域肝臟RFA術(shù)前及術(shù)后圖像信號(hào)ADC值之間進(jìn)行多個(gè)隨機(jī)樣本參數(shù)采用單因素方差分析(one-way ANOVA)的Tukey分析,對(duì)RFA術(shù)后中心消融區(qū)及殘留區(qū)之間的比較采用Wilcoxon非參數(shù)檢驗(yàn),以P0.05作為有顯著性差異。 結(jié)果： RFA術(shù)前及術(shù)后,正常肝組織的ADC值的變化無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。RFA術(shù)后中心完全消融區(qū)域的ADC值變化,術(shù)后均比術(shù)前升高,有顯著性差異(P0.05)。周邊可疑復(fù)發(fā)區(qū)域的ADC值,術(shù)前與術(shù)后的差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。RFA術(shù)后隨訪中,中心消融區(qū)較殘留區(qū)ADC值均有顯著升高(P0.05)。殘留結(jié)節(jié)均由磁共振增強(qiáng)掃描圖像及超聲造影檢查確診。 結(jié)論： 本研究對(duì)于轉(zhuǎn)移性肝癌RFA術(shù)后的病灶DWI圖像信號(hào)進(jìn)行了分析。通過(guò)ADC值的變化,RFA術(shù)后7天及后期隨訪中殘留結(jié)節(jié)的ADC較術(shù)前均未發(fā)生顯著變化,故可依此在早期發(fā)現(xiàn)殘留結(jié)節(jié),為進(jìn)一步治療提供了可靠診斷依據(jù),對(duì)于提高完全消融率及延長(zhǎng)患者的生存期具有一定意義。
[Abstract]:Background and Purpose :

The prognosis of metastatic liver cancer depends on the location of the primary tumor , the range of liver involvement and the systemic condition of the patient , and the 1 - year survival rate is less than 50 % . Therefore , it is the current medical challenge to select the appropriate treatment plan and extend the effective survival time of the patient as far as possible .

With the development of medical science , there have been effective non - surgical treatments besides surgical treatment , including radiofrequency ablation , hepatic artery embolization chemotherapy , immunotherapy , etc .

DWI is a sensitive imaging technique for the diffusion of water molecules .

In recent years , the study of liver DWI is much more , including the evaluation of TACE and postoperative effects of TACE . However , there has not been a study of postoperative residual liver cancer . The aim of this study is to explore the possibility of early detection of residual nodules by the change of ADC values in different regions of the lesions after the resection of hepatic carcinoma .

Method :

A single - factor ANOVA ( ANOVA ) was used to analyze the ADC values between different regions of the liver and the residual area was analyzed by means of single - way ANOVA .

Results :

There was no significant difference in ADC values of normal liver tissues before and after operation ( P0.05 ) . The ADC values of the central ablation region were significantly higher than those before operation ( P0.05 ) .

Conclusion :

The results showed that the residual nodules were found in the early stage and the later follow - up , so the residual nodules could be found in the early stage , thus providing a reliable diagnostic basis for further treatment , which has some significance for improving the complete ablation rate and prolonging the survival time of the patients .
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.7;R445.2

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本文編號(hào)：2103920