【摘要】：目的： 探討實(shí)時(shí)超聲造影技術(shù)在原發(fā)性肝癌射頻消融治療中應(yīng)用的臨床價(jià)值。 方法： 收集吉林大學(xué)第一醫(yī)院腫瘤中心2012年9月到2013年6月期間在實(shí)時(shí)超聲造影指導(dǎo)下進(jìn)行肝癌射頻消融術(shù)的70例原發(fā)性肝癌患者的臨床資料，并選取2011年5月到2012年8月期間僅在普通超聲引導(dǎo)下進(jìn)行射頻消融術(shù)的74例原發(fā)性肝癌患者作為對(duì)照，比較兩組患者的臨床特征（性別、年齡、Child分級(jí)、腫瘤大小、腫瘤數(shù)量等）、術(shù)前同CT/MRI檢查的符合率、術(shù)后常見(jiàn)并發(fā)癥（如發(fā)熱、疼痛、血壓升高、出血等）的發(fā)生情況。并對(duì)上述患者于術(shù)后1個(gè)月采用增強(qiáng)CT或（和）MRI等影像學(xué)檢查進(jìn)行療效的評(píng)價(jià)，之后每3個(gè)月規(guī)律應(yīng)用增強(qiáng)CT或（和）MRI進(jìn)行隨訪，比較無(wú)進(jìn)展生存情況。 結(jié)果： 超聲造影組70例患者，超聲造影表現(xiàn)為動(dòng)脈期高增強(qiáng)56例（80.0%），增強(qiáng)CT/MRI表現(xiàn)動(dòng)脈期增強(qiáng)53例（75.7%），其中超聲造影同增強(qiáng)CT或MRI中有49例（70.0%）病灶增強(qiáng)模式表現(xiàn)一致（kappa=0.84）。超聲造影界定病灶大小為（2.72±0.933）cm，大于應(yīng)用普通超聲的病灶大小界定范圍（2.53±0.944）cm（P=0.042）。超聲造影組患者術(shù)后發(fā)生并發(fā)癥者34例（48.6%），對(duì)比普通超聲造影組患者相關(guān)術(shù)后并發(fā)癥為43例（58.1%），，兩組無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。術(shù)后1個(gè)月應(yīng)用CT或（和）MRI進(jìn)行隨訪，超聲造影組有6例病灶原位復(fù)發(fā)（8.6%），普通超聲組18例出現(xiàn)原位復(fù)發(fā)（24.3%），二者比較具有統(tǒng)計(jì)學(xué)意義（χ2=6.427，P0.05）。兩組患者的中位隨訪時(shí)間為12個(gè)月（4~16個(gè)月），超聲造影組6個(gè)月無(wú)進(jìn)展生存率為63.0%，普通超聲組為45.3%；超聲造影組1年無(wú)進(jìn)展生存期為76.8%，普通超聲組為70.6%。對(duì)比中位生存期，普通超聲造影組為11.7個(gè)月，超聲造影組未達(dá)到中位生存期。超聲造影組無(wú)病生存期要長(zhǎng)于對(duì)照組，具有統(tǒng)計(jì)學(xué)意義。針對(duì)病灶≥3cm的患者，6個(gè)月時(shí)造影組無(wú)進(jìn)展生存率為74.8%，普通超聲組為48.0%；1年超聲造影組無(wú)進(jìn)展生存期為68.0%，普通超聲組為30.8%。對(duì)比中位生存期，普通超聲造影組為6.6個(gè)月。超聲造影組未達(dá)到中位生存期。超聲造影組無(wú)病生存期要長(zhǎng)于對(duì)照組，具有統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論： 超聲造影可作為增強(qiáng)CT或MRI檢查的有益補(bǔ)充。超聲造影術(shù)中顯影良好，可對(duì)射頻消融術(shù)起到實(shí)時(shí)指導(dǎo)作用，減少腫瘤局部存活率，延長(zhǎng)無(wú)病生存期，同時(shí)一定程度上減少相關(guān)并發(fā)癥的發(fā)生。
[Abstract]:Objective: to evaluate the clinical value of real-time contrast-enhanced ultrasound in radiofrequency ablation of primary liver cancer. Methods: the clinical data of 70 patients with primary liver cancer undergoing radiofrequency ablation under the guidance of real-time contrast-enhanced ultrasound from September 2012 to June 2013 in the tumor Center of the first Hospital of Jilin University were collected. From May 2011 to August 2012, 74 patients with primary liver cancer undergoing radiofrequency ablation under the guidance of general ultrasound were selected as control group. The clinical features (sex, age, Child grade, tumor size) were compared between the two groups. The incidence of postoperative complications (such as fever, pain, elevated blood pressure, bleeding, etc.). The patients were evaluated with enhanced CT or / and MRI at 1 month after operation, and then followed up regularly with enhanced CT or / and MRI every 3 months. Results: in contrast echocardiography group, 56 cases (80.0%) showed high enhancement in arterial phase and 53 cases (75.7%) showed arterial phase enhancement in contrast enhanced CT/MRI. Contrast-enhanced ultrasonography was consistent with enhanced CT or MRI in 49 cases (70.0%). The size of the lesion was (2.72 鹵0.933) cm, in contrast-enhanced ultrasound and (2.53 鹵0.944) cm (P0.042) in the conventional ultrasound. The postoperative complications occurred in 34 cases (48.6%) in contrast group, compared with 43 cases (58.1%) in general contrast group. There was no significant difference between the two groups (P0.05). One month after operation, CT or / and MRI were used to follow up, 6 cases (8.6%) of lesions recurred in situ in contrast-enhanced ultrasound group and 18 cases (24.3%) in common ultrasound group. There was significant difference between the two groups (蠂 ~ 26.427, 蠂 ~ (2) 6.427). P0.05). The median follow-up time of the two groups was 12 months (4-16 months). The progression free survival rate was 63.0 in the contrast-enhanced ultrasound group and 45.3 in the general ultrasound group. The 1 year progression-free survival time was 76. 8 in contrast ultrasound group and 70.6 in general ultrasound group. The median survival time was 11.7 months in the conventional contrast echocardiography group, but the median survival time was not reached in the contrast-enhanced ultrasound group. The disease-free survival time of contrast-enhanced ultrasound group was longer than that of control group, which was statistically significant. For the patients with lesions 鈮

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