本文關(guān)鍵詞：超聲造影在經(jīng)皮肝穿刺無水酒精治療肝癌術(shù)中的應(yīng)用研究　出處：《浙江大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 無水酒精 超聲造影 經(jīng)皮肝穿注射無水酒精治療 肝癌

【摘要】：目的： 將超聲造影(contrast-enhanced ultrasound, CEUS)應(yīng)用于經(jīng)皮肝穿刺無水酒精治療(percutaneous ethnol injection, PEI)肝癌術(shù)的術(shù)前、術(shù)中、術(shù)后,尋求PEI術(shù)治療肝癌的量化方法,探討超聲造影的應(yīng)用價(jià)值。 資料和方法： 研究對(duì)像為38例準(zhǔn)備行PEI術(shù)治療的肝癌患者,包括32例原發(fā)性肝細(xì)胞癌(hepatocellular carcinoma, HCC),2例肝內(nèi)膽管細(xì)胞癌(Intrahepatic cholangio-carcinoma, ICC),4例轉(zhuǎn)移性肝癌(metastatic liver cancer, MLC),男28例,女10例,年齡51-79歲,平均62.2歲。術(shù)前完善常規(guī)檢查并超聲造影,記錄肝癌結(jié)節(jié)的位置、大小、血供特點(diǎn),并據(jù)此規(guī)劃PEI術(shù)中的進(jìn)針點(diǎn),布針方式,酒精用量等；術(shù)中行超聲造影,在超聲造影模式下引導(dǎo)酒精針的進(jìn)入,并根據(jù)超聲造影下肝癌結(jié)節(jié)的血供特點(diǎn)實(shí)時(shí)調(diào)整酒精針的位置,恰當(dāng)布針,根據(jù)每枚酒精針的深度與位置,按先深后淺,先邊緣高危部分后中心安全部位的順序,依次緩慢注射無水酒精,實(shí)時(shí)觀察無水酒精注入肝癌結(jié)節(jié)后的彌散情況,以無水酒精均勻彌散于肝癌結(jié)節(jié)并超出結(jié)節(jié)邊緣1.0cm為標(biāo)準(zhǔn),術(shù)中密切觀注患者的生命體征；術(shù)后一周對(duì)患者復(fù)查肝功能及腫瘤指標(biāo),并行超聲造影,評(píng)估治療效果及肝臟損傷情況,決定是否重復(fù)上述PEI術(shù)過程,直至病人肝癌結(jié)節(jié)在超聲造影狀態(tài)下完全滅活視作治療完成。詳細(xì)記錄患者PEI治療的次數(shù),總共所使用的酒精針數(shù)量,無水酒精的用量等,治療過程不良反應(yīng)發(fā)生情況,隨訪全部患者肝功能及腫瘤指標(biāo)變化情況,半年及一年復(fù)發(fā)率及生存率。 結(jié)果： 1.全部38例患者共進(jìn)行了100次PEI治療,共使用PTC酒精針具297枚,無水酒精總使用量為752ml。PEI術(shù)治療次數(shù)(N),PTC酒精針用量(M),無水酒精用量(V)均與肝癌結(jié)節(jié)最大徑(D)呈顯著正相關(guān),回歸方程分別為N=1.453D-0.9889(R=0.811, P0.001), M=5.613D-6.173(R=0.823, P0.001), V=8.022D-0.203(R=0.631, P0.001)。 2.在PEI術(shù)超聲造影前對(duì)38例肝癌結(jié)節(jié)位置及大小、浸潤范圍的顯示判斷優(yōu)于常規(guī)彩超,本組38例肝癌結(jié)節(jié)中10例常規(guī)彩超不能清晰顯示,而超聲造影顯示清晰,另28例常規(guī)彩超聲雖能顯示,但其大小測量值與超聲造影相比偏��；術(shù)中超聲造影可以清晰顯示肝癌結(jié)節(jié)的有血供的活性部分,精確引導(dǎo)無水酒精到達(dá)治療靶點(diǎn),而常規(guī)彩超無法做到；肝癌結(jié)節(jié)在PEI術(shù)后會(huì)產(chǎn)生多種聲像圖改變,常規(guī)彩超無法判斷術(shù)后肝癌結(jié)節(jié)壞死滅活情況及復(fù)發(fā)情況,而術(shù)后超聲造影可以顯示肝實(shí)質(zhì)及肝癌結(jié)節(jié)的血供情況,對(duì)PEI術(shù)的療效做出準(zhǔn)確的評(píng)估。 3.全部38例患者在治療過程中無一例發(fā)生嚴(yán)重并發(fā)癥,未發(fā)現(xiàn)因治療引起腫瘤轉(zhuǎn)移和局部播散,治療過程中主要并發(fā)癥有穿刺部分疼痛、發(fā)生率為78.9%,發(fā)熱、發(fā)生率為21.1%,肝功能指標(biāo)下降、發(fā)生率為15.8%,胸悶頭暈、發(fā)生率為16.7%,腹部不適及嘔吐、發(fā)生率為16.7%。 4.全部38例患者治療完成后,32例原發(fā)性肝細(xì)胞癌患者腫瘤指標(biāo)下降率為100%,轉(zhuǎn)陰率為87.5%；2例肝內(nèi)膽管細(xì)胞癌腫瘤指標(biāo)1例轉(zhuǎn)陰,1例下降未轉(zhuǎn)陰；轉(zhuǎn)移性肝癌腫瘤指標(biāo)均有不同程度下降,下降率為100%,但均末見轉(zhuǎn)陰。 5.本組38例患者半年及一年生存率分別為97.3%、89.5%,復(fù)發(fā)率分別為5.3%、13.2%。 結(jié)論： 應(yīng)用超聲造影,在PEI術(shù)前能夠準(zhǔn)確評(píng)估腫瘤大小、浸潤范圍、判斷毗鄰關(guān)系,可以幫助規(guī)劃手術(shù)方式,術(shù)中可以準(zhǔn)確引導(dǎo)并幫助精準(zhǔn)消融病灶,術(shù)后可以客觀評(píng)估治療效果；超聲造影技術(shù)的應(yīng)用可量化指導(dǎo)PEI術(shù)治療肝癌,有望提高PEI術(shù)治療肝癌的效果。
[Abstract]:Objective:
Contrast-enhanced ultrasound (CEUS) was applied in the preoperative, intraoperative and postoperative percutaneous liver biopsy (percutaneous ethnol injection PEI) for the treatment of hepatocellular carcinoma.
Information and methods:
Study on Preparation and PEI treatment like 38 cases of liver cancer patients, including 32 cases of primary hepatocellular carcinoma (hepatocellular, carcinoma, HCC), 2 cases of intrahepatic cholangiocarcinoma (Intrahepatic, cholangio-carcinoma, ICC), 4 cases of metastatic liver cancer (metastatic liver, cancer, MLC), 28 cases were male, 10 female patients, age 51-79 years, average 62.2 years old. Perfect preoperative routine examination and ultrasonography, recording nodules location, size, blood supply, and the needle point according to this planning in PEI surgery, needle, alcohol dosage; intraoperative contrast-enhanced ultrasound, contrast-enhanced ultrasound guided mode in alcohol into the needle the adjustment for alcohol and needle position in real time according to the characteristics of blood liver nodules in ultrasound contrast, proper needle placement, according to the depth and position of each needle by alcohol, deep to shallow, the first part after the security center edge high-risk parts of the order, followed by slow injection of anhydrous alcohol. The observation of injecting anhydrous alcohol dispersion of liver nodules after, with anhydrous alcohol evenly dispersed in the nodules and nodules edge beyond the 1.0cm standard, with close attention of the vital signs of the patients; one week after the surgery of liver function in patients and tumor markers, parallel contrast-enhanced ultrasound, evaluating the therapeutic effect and liver injury, decision whether to repeat the above process until PEI surgery, patients of liver nodules in ultrasound contrast state completely inactivated as treatment is completed. The number of detailed records of patients with PEI treatment, the total number of needles used by alcohol, anhydrous alcohol dosage, the occurrence of adverse reactions during the treatment and follow-up of all patients with liver function and tumor index changes, the first half and one year recurrence rate and survival rate.
Result錛，

本文編號(hào)：1400577