【摘要】：目的：射頻消融(Radiofrequency Ablation, RFA)是肝癌局部的非手術的有效治療方法之一，治療后對于療效的評估是關鍵步驟。有研究證明超聲造影(Contrast Enhanced Ultrasound, CEUS)與增強CT或MR一樣可用來評估療效，但即時的療效評估因射頻過程產(chǎn)生的氣體及治療導致的炎癥充血影響而存在技術難點。我們先進行動物試驗(體內/外)，結果發(fā)現(xiàn)實時超聲彈性成像(Real-time Ultrasound Elastography, RTE)可用于評估消融范圍，其能否用于評估人體內消融病灶的報道甚少，值得研究。因此，本研究擬利用RTE觀察人體內肝癌射頻消融病灶，并與常規(guī)超聲(Base-line Ultrasound,BUS)、CEUS比較，探討RTE判斷RFA療效的臨床應用價值。 方法：2012年5月至2013年3月，在我院肝膽外科住院行RFA治療的29個患者共34個肝癌病灶納入本研究，全部病灶均經(jīng)肝穿活檢病理證實為肝細胞癌(Hepatocellular Carcinoma, HCC)。BUS、RTE及CEUS分別于RFA治療前一周內、RFA治療后24h進行。觀察三種方法對RFA消融灶的顯示，以經(jīng)過射頻針的最大切面為測量切面并測量消融灶長軸、短軸，并進行對比分析。定量資料以均數(shù)±標準差表示。正態(tài)資料分布采用配伍組設計方差分析，，Pearson相關分析。以Ｐ＜0.05(雙側)定義為差異有統(tǒng)計學意義。使用SPSS16.0進行統(tǒng)計分析。 結果：RFA治療后24h，BUS顯示全部病灶呈不均質回聲；RTE圖像顯示32(94.1%)例呈消融區(qū)均勻藍色或藍色為主分布，與周圍組織分界清晰，而2(5.9%)例呈藍綠色相間顏色分布，與周圍肝組織分界不清；CEUS圖像顯示消融區(qū)動脈期、門脈期及延遲期均為無增強，消融灶周邊組織因炎癥反應而呈現(xiàn)為動脈期高增強，門脈期及延遲期表現(xiàn)為等增強或稍低增強。BUS、RTE及CEUS顯示消融范圍測值的比較有顯著性差異(P0.01)，兩兩比較顯示BUS與RTE、BUS與CEUS測值差別有統(tǒng)計學意義(P＜0.05)，而RTE與CEUS測值差別無統(tǒng)計學意義(P＞0.05)。pearson相關分析顯示RTE與CEUS顯示消融灶長軸、短軸的相關系數(shù)分別為0.878與0.788。 結論：RTE有望為評估肝癌射頻消融灶提供一種有效的、簡便的方法。
[Abstract]:Objective: radiofrequency ablation (Radiofrequency Ablation, RFA) is one of the effective methods for local non-surgical treatment of hepatocellular carcinoma (HCC), and it is a key step to evaluate the curative effect after treatment. Some studies have shown that contrast-enhanced (Contrast Enhanced Ultrasound, CEUS) can be used to evaluate the efficacy as well as enhanced CT or MR, but there are technical difficulties in the immediate evaluation of therapeutic efficacy due to the gas produced by the radiofrequency process and the effects of inflammatory congestion caused by treatment. We first conducted animal experiments (in vivo / in vitro) and found that real-time ultrasound elastography (Real-time Ultrasound Elastography, RTE) can be used to assess the extent of ablation, and whether it can be used to evaluate ablation lesions in human body is rarely reported, which is worth studying. Therefore, the purpose of this study is to observe the radiofrequency ablation focus of human hepatocellular carcinoma by RTE and compare it with conventional ultrasound (Base-line Ultrasound,BUS), CEUS) to evaluate the clinical value of RTE in evaluating the curative effect of RFA. Methods: from May 2012 to March 2013, 34 HCC lesions from 29 patients treated with RFA in our hepatobiliary surgery were included in this study. All the lesions were pathologically proved to be hepatocellular carcinoma (Hepatocellular Carcinoma, HCC). BUS,) by liver biopsy. RTE and CEUS were performed within one week before RFA treatment and 24 hours after RFA treatment. The display of RFA ablation focus by three methods was observed. The maximum section of radiofrequency needle was used as the measuring section and the long axis and short axis of ablation focus were measured and compared and analyzed. The quantitative data were expressed as mean 鹵standard deviation. Normal data distribution was analyzed by compatibility group design analysis of variance and Pearson correlation analysis. The difference was statistically significant in terms of P < 0.05 (bilateral). SPSS16.0 was used for statistical analysis. Results: twenty-four hours after RFA treatment, bus showed heterogeneous echo of all lesions. RTE images showed that 32 cases (94.1%) showed a uniform blue or blue distribution in the ablation area, and the boundary was clear with the surrounding tissues, while in 2 (5.9%) cases, the color distribution was blue-green and not clear with the surrounding liver tissue. CEUS showed no enhancement in the arterial phase, portal phase and delayed phase in the ablation area. The peripheral tissue of the ablation area showed a high enhancement due to inflammation, and an equal or slightly low enhancement in the portal phase and delayed phase. Bus, the arterial phase, the portal phase and the delayed phase of the ablation area showed no enhancement in the arterial phase, portal vein phase and delayed phase. RTE and CEUS showed significant difference in ablation range (P0.01). There was significant difference between BUS and RTE,BUS and CEUS in pairwise comparison (P < 0.05). There was no significant difference between RTE and CEUS (P > 0.05). Pearson correlation analysis showed that RTE and CEUS showed long axis and short axis correlation coefficient was 0.878 and 0.788 respectively. Conclusion: RTE may provide an effective and simple method for evaluating radiofrequency ablation of hepatocellular carcinoma.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R735.37;R445.1

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