本文選題：肝臟 + 射頻消融　； 參考：《貴州醫(yī)科大學》2017年碩士論文

【摘要】：目的探究常規(guī)超聲與超聲造影(contrast-enhanced ultrasound,CEUS)判斷活體豬肝射頻消融灶范圍的價值以及超聲造影判斷活體豬肝射頻消融灶是否完全消融的價值。方法選用10只小型活體豬肝在常規(guī)超聲引導下進行射頻消融(radiofrequency Ablation,RFA),然后在RFA結束后即刻予以常規(guī)超聲掃描射頻消融灶范圍,選取射頻消融灶在常規(guī)超聲檢查中的最大切面測量消融灶的左右徑、垂直徑,常規(guī)超聲檢查結束后即刻行超聲造影檢查,先予以常規(guī)超聲掃描活體豬肝,選定射頻消融灶掃描的最大切面,切換至造影模式,將超聲造影劑經耳緣靜脈團注,在CUES動脈期檢查顯示的射頻消融灶最大切面中測量其左右徑、垂直徑,并且根據CEUS檢查的動脈期、門脈期、延遲期消融灶影像學表現判斷活體豬肝射頻消融灶是否完全消融。在活體豬肝內射頻消融實驗結束后將實驗小豬處死,解剖出整個活體豬肝,切取射頻消融灶所在的肝葉或肝段,然后將射頻消融灶切開并測量射頻消融灶切面的左右徑、垂直徑。最后將射頻消融灶所在肝葉或肝段的大體標本進行HE染色,在光學顯微鏡下行組織病理學檢查判斷射頻消融灶內是否有正常肝細胞的殘留。最后將常規(guī)超聲、超聲造影、大體標本所測量射頻消融灶的左右徑、垂直徑、面積進行比較,以及將超聲造影和大體標本判斷射頻消融灶是否完全消融的結果進行比較。結果本實驗中共采用10只活體豬肝在常規(guī)超聲引導下進行射頻消融,共產生43個射頻消融灶,其中活體豬肝射頻消融灶在常規(guī)超聲檢查中所測量最大切面的左右徑、垂直徑、面積分別是3.27±0.51cm、2.81±0.50cm、7.20±1.59cm2,相應的在超聲造影檢查時所測量活體豬肝射頻消融灶的左右徑、垂直徑、面積是分別是3.36±0.57cm、2.90±0.55cm、7.60±1.65cm2,相應射頻消融灶所在肝葉或肝段大體標本所測量的左右徑、垂直徑、面積是3.40±0.60cm、2.88±0.55cm、7.66±1.79cm2,常規(guī)超聲與超聲造影、常規(guī)超聲與大體標本所測量的射頻消融灶范圍結果比較差異均具有統(tǒng)計學意義(P均0.05),但是各測量值行線性相關性分析時相關性均較高;超聲造影與大體標本測量射頻消融灶范圍結果比較差異均無統(tǒng)計學意義(P均0.05),而且各測量值行線性相關性分析時相關性均極高。以活體豬肝射頻消融灶所在肝葉或肝段大體標本的組織切片病理檢查結果為“金標準”,CEUS判斷射頻消融灶有15個表現完全消融,28個表現為不完全消融,而活體豬肝射頻消融灶所在肝葉或肝段大體標本的組織切片病理檢查結果判斷有13個射頻消融灶為完全消融,30個射頻消融灶為不完全消融。因此,超聲造影檢查判斷的結果中有5個完全消融灶和3個不完全消融灶與活體豬肝射頻消融灶所在肝葉或肝段大體標本的組織切片病理檢查結果不一致,因此,將組織切片病理檢查結果為“金標準”時,超聲造影檢查判斷消融灶殘留的準確性為81.4%,敏感性83.3%,特異性76.9%,CEUS與大體標本的組織切片病理檢查判斷消融灶是否完全消融的結果相一致,McNemar檢驗P=0.7270.05差異無統(tǒng)計學意義。結論在RFA術后常規(guī)超聲判斷活體豬肝射頻消融灶范圍的價值有限,超聲造影能夠為RFA術后判斷活體豬肝射頻消融灶范圍及是否完全消融提供可靠的影像學判斷依據。
[Abstract]:Objective to explore the value of contrast-enhanced ultrasound (CEUS) to determine the range of radiofrequency ablation range in living pig liver and to determine the value of radiofrequency ablation in living pig liver by contrast-enhanced ultrasound. Methods radiofrequency ablation (radiofrequency Ablat) was performed under conventional ultrasound guidance in 10 small living pig liver (radiofrequency Ablat). Ion, RFA), then the radiofrequency ablation range was scanned by conventional ultrasonic scanning at the end of RFA, and the radiofrequency ablation range was selected to measure the left and right diameter of the ablation area, the vertical diameter, and the radiofrequency examination was performed immediately after the routine ultrasound examination. The maximum section of the sketch is switched to the contrast mode, and the ultrasound contrast agent is injected through the auricular vein, and the diameter and diameter of the radiofrequency ablation range are measured in the maximum section of the radiofrequency ablation range of the CUES arterial phase, and the radiofrequency ablation focus of the living pig liver is determined according to the CEUS examination of the arterial phase, the portal phase, and the delayed ablation range. At the end of the radiofrequency ablation experiment in living pig liver, the experimental pig was killed, the whole living pig liver was dissected, the liver leaf or liver segment of the radiofrequency ablation stove was cut, and the radiofrequency ablation range was cut and measured, and the vertical diameter of the radiofrequency ablation area was measured. Finally, the gross specimens of the liver and liver segments of the radiofrequency melting stove were stained with HE. To determine whether there is a normal liver cell in the radiofrequency ablation range under the optical microscope, and to compare the diameter, the vertical diameter and the area of the radiofrequency ablation range by conventional ultrasound, ultrasound contrast, and gross specimen, and to determine whether the radiofrequency ablation focus is completely ablation. Results the results were compared. Results there were 43 radiofrequency radiofrequency ablation of 10 living pig liver under conventional ultrasound guidance, and 43 radiofrequency ablation foci were produced. The diameter of the maximum section, vertical diameter, and area were 3.27 + 0.51cm, 2.81 + 0.50cm, 7.20 + 1.59cm2, in the routine ultrasound examination of the living pig liver radiofrequency ablation. The left and right diameter of the radiofrequency ablation foci of living pig liver were measured at 3.36 + 0.57cm, 2.90 + 0.55cm, 7.60 + 1.65cm2 respectively, and the vertical diameter was 3.40 + 0.60cm, 2.88 + 0.55cm, 7.66 + 1.79cm2, conventional ultrasound and super. There were significant differences in the range of radiofrequency ablation range measured by conventional ultrasound and general specimen (P 0.05), but the correlation was higher when the measured values were linear correlation analysis, and there was no significant difference between the radiofrequency ablation range and the gross specimen (P 0.05). The correlation between the measured values and the linear correlation analysis was very high. The pathological examination results of the tissue sections of the liver lobe or liver segment of the living pig liver radiofrequency ablation foci were "gold standard". CEUS showed that 15 radiofrequency ablation foci were completely ablation and 28 showed incomplete melting, while the liver lobes of living pig liver radiofrequency ablation foci were located in the liver. 13 radiofrequency ablation foci were completely ablation and 30 radiofrequency ablation foci were incomplete ablation. Therefore, there were 5 complete ablation and 3 incomplete ablation foci in the results of radiofrequency ablation in the liver and liver segments of the living pig liver. The results of pathological examination were inconsistent. Therefore, when the pathological examination results of tissue section were "gold standard", the accuracy of ultrasonic contrast examination was 81.4%, sensitivity 83.3% and specificity 76.9%. The results of CEUS and histological examination of gross specimens were consistent with the results of completely ablation of the ablation focus, McNemar examination. There is no statistical significance in the difference of P=0.7270.05 test. Conclusion the value of conventional ultrasound in determining the range of radiofrequency ablation range of living pig liver after RFA is limited, and the ultrasound contrast can provide a reliable basis for judging the range of radiofrequency ablation range and complete ablation of living pig liver after RFA.
【學位授予單位】：貴州醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.1;R735.7

【參考文獻】

相關期刊論文 前10條

1 袁惠;牛錦東;張梓楨;彭娟;陳洪艷;;三維超聲造影對肝癌射頻治療的評價[J];中國超聲醫(yī)學雜志;2015年06期

2 王磊;徐慶祥;丁義濤;;術前肝臟功能評估在肝臟手術方案設計中的應用價值[J];東南大學學報(醫(yī)學版);2013年06期

3 王曉東;梁群興;趙萍;;超聲造影和彩色多普勒超聲在原發(fā)性肝細胞肝癌診斷中的應用[J];廣東醫(yī)學;2013年12期

4 黃建釗;劉江偉;孫倩;偠欣;張佳偉;趙鵬偉;;射頻消融與手術切除治療肝癌的療效比較[J];廣東醫(yī)學;2012年13期

5 李倩;杜佳;關鵬;杜君;曲春楓;代敏;;中國2008年肝癌發(fā)病、死亡和患病情況的估計與預測[J];中華流行病學雜志;2012年06期

6 陳建國;;中國肝癌發(fā)病趨勢和一級預防[J];臨床肝膽病雜志;2012年04期

7 時正義;;影像學檢查在原發(fā)性肝癌TACE術后療效評價中的應用價值及進展[J];華夏醫(yī)學;2011年06期

8 孫開宇;譚薇;甄永強;譚強;王樂強;;超聲引導下射頻消融治療局部晚期肺癌的近期療效[J];現代腫瘤醫(yī)學;2011年11期

9 黃亞勇;杜勇;楊漢豐;孟俊;李兵;;肝癌射頻消融術后的影像學評價[J];中華臨床醫(yī)師雜志(電子版);2011年15期

10 王文平;毛麗娟;丁紅;黃備建;李叢;李超倫;;動態(tài)三維超聲造影在肝腫瘤診斷中的初步應用[J];中華醫(yī)學超聲雜志(電子版);2011年05期

，

本文編號：1920374