本文選題：超聲 + 激光消融��； 參考：《東南大學(xué)》2017年碩士論文

【摘要】：小肝癌是指單個(gè)肝癌結(jié)節(jié)直徑≤3cm或者相鄰兩個(gè)肝癌結(jié)節(jié)的直徑之和≤3cm,其早期診治是提高患者生存質(zhì)量、降低死亡率的關(guān)鍵舉措[1]。現(xiàn)在臨床上治療小肝癌的首選治療手段仍為手術(shù)切除,但由于大部分肝癌患者伴有肝炎、肝硬化等基礎(chǔ)疾病,不適宜采取手術(shù)切除的方式,從而使得非手術(shù)手段在小肝癌治療中的應(yīng)用越來越廣泛。近年來,隨著診療技術(shù)的進(jìn)步,小肝癌的早期診斷率越來越高,原位消融肝癌治療技術(shù)已逐步成為小肝癌首選的治療措施[2],其中射頻消融術(shù)(RFA)具有安全可靠、易耐受、術(shù)后并發(fā)癥少等優(yōu)勢(shì),在造成局部肝細(xì)胞死亡同時(shí)保留了肝臟組織的正常形態(tài),是繼手術(shù)切除和肝臟移植之后的首選治療手段。與此同時(shí),近期新發(fā)展起來的激光消融術(shù)(LA)也被應(yīng)用于肝癌的治療。本研究通過對(duì)超聲引導(dǎo)下激光消融和射頻消融治療小肝癌病例療效的對(duì)比性分析,探討超聲引導(dǎo)下激光消融和射頻消融兩種方法在介入治療小肝癌方面的優(yōu)缺點(diǎn),為臨床治療肝癌提供更優(yōu)化的治療方案以及數(shù)據(jù)支持。本研究分為兩個(gè)部分:第一部分:在超聲引導(dǎo)下進(jìn)行小肝癌的激光消融治療,對(duì)激光消融前后的超聲造影結(jié)果及治療指標(biāo)進(jìn)行比較,同時(shí)記錄發(fā)生的各種并發(fā)癥,分析激光治療小肝癌的效果,為激光消融和射頻消融的比較奠定基礎(chǔ)。第二部分:在第一部分的基礎(chǔ)上,將兩組小肝癌患者分別進(jìn)行激光消融和射頻消融治療,將兩種消融方法的超聲造影結(jié)果及評(píng)價(jià)指標(biāo)進(jìn)行組間比較,同時(shí)記錄發(fā)生的各種并發(fā)癥,分析激光消融和射頻消融治療小肝癌的優(yōu)缺點(diǎn)。第一部分超聲引導(dǎo)下激光消融小肝癌的治療效果目的探討在超聲引導(dǎo)下激光消融治療小肝癌的治療效果。方法選取2013年10月～2015年3月于江陰市人民醫(yī)院就診且血清甲胎蛋白(AFP)升高的原發(fā)性小肝癌患者27例共31個(gè)病灶,在超聲引導(dǎo)下進(jìn)行激光消融(LA)治療,將治療后一個(gè)月的超聲造影(CEUS)結(jié)果和AFP水平與術(shù)前進(jìn)行比較,并統(tǒng)計(jì)各種并發(fā)癥的發(fā)生率,分析激光消融治療小肝癌的效果。結(jié)果與治療前相比,治療后超聲造影顯示病灶完全緩解率87.1%(28/31),部分緩解率12.9%(3/31),AFP較術(shù)前明顯降低且術(shù)后并發(fā)癥輕微,其中腹痛發(fā)生率59.2%,發(fā)熱發(fā)生率11.1%,惡心發(fā)生率44.4%,嘔吐發(fā)生率18.5%,腹瀉發(fā)生率3.7%。結(jié)論激光消融對(duì)小肝癌患者有著較好的治療效果,且術(shù)后并發(fā)癥發(fā)生率低而輕。第二部分超聲引導(dǎo)下激光和射頻消融治療小肝癌的效果比較目的對(duì)超聲引導(dǎo)下激光和射頻消融治療小肝癌的效果進(jìn)行比較,分析激光消融和射頻消融治療小肝癌的優(yōu)缺點(diǎn)。方法選擇行消融治療的原發(fā)性小肝癌患者93例,分為激光消融組(LA組)43例52個(gè)病灶和射頻消融組(RFA組)50例57個(gè)病灶,比較兩種消融方法的治療效果和血清甲胎蛋白(AFP)的恢復(fù)情況,記錄兩組治療的各種并發(fā)癥的發(fā)生率并進(jìn)行比較。結(jié)果超聲造影結(jié)果顯示LA組完全緩解率90.4%(47/52),部分緩解率9.6%(5/52),RFA完全緩解率91.2%(52/57),部分緩解率8.8%(5/57),兩組之間差異無統(tǒng)計(jì)學(xué)意義(p0.05);兩組小肝癌患者血清甲胎蛋白(AFP)水平較術(shù)前均明顯降低且兩組間恢復(fù)率未見明顯統(tǒng)計(jì)學(xué)差異(p0.05);各種并發(fā)癥中,兩組之間輕微并發(fā)癥發(fā)生率兩組之間無明顯統(tǒng)計(jì)學(xué)差異(P0.05),嚴(yán)重并發(fā)癥的發(fā)生率RFA組明顯高于LA組(p0.05)。結(jié)論超聲引導(dǎo)下LA和RFA均是治療小肝癌的有效方法,相比而言,LA操作簡(jiǎn)單,嚴(yán)重并發(fā)癥的發(fā)生率較RFA低。
[Abstract]:Small hepatocellular carcinoma (HCC) refers to the diameter of a single hepatoma nodule in diameter less than 3cm or the diameter of two adjacent liver nodules or less than 3cm. Early diagnosis and treatment is the key measure to improve the patient's quality of life and reduce the mortality rate. The first choice of treatment for small hepatocellular carcinoma is still surgical excision, but most of the liver cancer patients are accompanied by hepatitis, cirrhosis and so on. Basic diseases, which are not suitable for surgical resection, make the use of non-surgical methods more and more widely used in the treatment of small liver cancer. In recent years, with the progress of diagnosis and treatment technology, the early diagnosis rate of small liver cancer is becoming higher and higher. In situ ablation of liver cancer treatment technology has gradually become the first choice for small liver cancer treatment [2], of which radiofrequency ablation is used. RFA, which has the advantages of safe and reliable, easy to endure, and less complications after operation, has retained the normal form of liver tissue in the cause of local hepatocyte death and is the first choice after surgical resection and liver transplantation. At the same time, the recent development of LA is also used in the treatment of liver cancer. A comparative analysis of the efficacy of ultrasound-guided laser ablation and radiofrequency ablation in the treatment of small hepatocellular carcinoma (RFCA). The advantages and disadvantages of two methods of interventional therapy for small hepatocellular carcinoma with ultrasound guided laser ablation and radiofrequency ablation are discussed, which provide more optimal treatment and data support for the clinical treatment of liver cancer. This study is divided into two parts: One part: the laser ablation treatment of small liver cancer under the guidance of ultrasound, compare the results of ultrasound contrast and treatment before and after laser ablation, record all kinds of complications, analyze the effect of laser treatment for small liver cancer, and lay the foundation for the ratio of laser ablation and radiofrequency ablation. The second part: the basis of the first part Two groups of small liver cancer patients were treated with laser ablation and radiofrequency ablation respectively. The results and evaluation indexes of the two ablation methods were compared, and the various complications were recorded. The advantages and disadvantages of laser ablation and radiofrequency ablation for the treatment of small liver cancer were analyzed. Objective to investigate the therapeutic effect of laser ablation in the treatment of small liver cancer under ultrasound guidance. Methods 27 patients with primary small hepatocellular carcinoma (HCC) who had been diagnosed with elevated serum alpha fetoprotein (AFP) in Jiangyin from October 2013 to March 2015 were selected and treated with laser ablation (LA) under ultrasound guidance. The results of CEUS and AFP were compared with preoperative, and the incidence of various complications was counted and the effect of laser ablation on small liver cancer was analyzed. Compared with before treatment, the total remission rate of the lesion was 87.1% (28/31), the partial inhibition rate was 12.9% (3/31), AFP was significantly lower and postoperative complications were significantly lower than that before the treatment. The incidence of abdominal pain was 59.2%, the incidence of fever was 11.1%, the incidence of nausea was 44.4%, the incidence of vomiting was 18.5%, and the incidence of diarrhea was 3.7%.. Conclusion laser ablation has a good therapeutic effect on the patients with small liver cancer, and the incidence of postoperative complications is low and light. Second parts of ultrasound guided laser and radiofrequency ablation for small liver cancer are compared. The advantages and disadvantages of laser ablation and radiofrequency ablation in the treatment of small liver cancer were compared, and the advantages and disadvantages of laser ablation and radiofrequency ablation in the treatment of small liver cancer were analyzed. Methods 93 cases of primary small hepatocellular carcinoma treated with ablation treatment were divided into 43 cases of laser ablation group (Group LA), 52 lesions and 50 cases of radiofrequency ablation group (group RFA) with 57 lesions, and two species were compared. The curative effect of the ablation method and the recovery of serum alpha fetoprotein (AFP) were recorded and the incidence of various complications in the two groups was recorded and compared. Results the complete remission rate of LA group was 90.4% (47/52), the partial remission rate was 9.6% (5/52), the rate of complete remission of RFA was 91.2% (52/57), the partial remission rate was 8.8% (5/57), and the difference between the two groups was different. There was no statistical significance (P0.05). The level of serum alpha fetoprotein (AFP) in two groups of small liver cancer patients was significantly lower than that before operation and no significant difference was found between the two groups (P0.05). Among the complications, there was no significant difference between the two groups between the two groups (P0.05), and the incidence of severe complications was significantly higher in the RFA group. In group LA (P0.05). Conclusion ultrasound guided LA and RFA are effective methods for the treatment of small hepatocellular carcinoma. Compared with LA, the operation is simple and the incidence of serious complications is lower than that of RFA.
【學(xué)位授予單位】：東南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7

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