摘要
目的探讨超声造影(CEUS)引导常规超声检查阴性(CUN)复发性肝细胞性肝癌(RHCC)射频消融(RFA)近期疗效分析。方法 2013年1月至2017年3月间,CUN拟在我院超声科CEUS引导下行经皮经肝射频消融RHCC患者108例113个病灶为CUN组,所有病例均有典型CECT/MRI影像学表现,并经CEUS在相应位置检出。按CEUS动脉期强化最大径(最大径)进行分组,最大径≤3 cm为N1组,最大径>3 cm为N2组;常规超声检查阳性(CUP)拟在常规超声引导下行经皮经肝射频消融RHCC患者88例94个病灶为对照组(CUP组),所有病灶RFA前行CEUS检查。分别于RFA后1个月、3个月及6个月复查CEUS/CECT/MRI,评估RFA后近期疗效。结果 CUN组与CUP组RFA后1个月、3个月、6个月组间疗效差异均无统计学意义(P=0.75,P=0.85,P=0.41)。N1组与N2组RFA后近期疗效比较:RFA后6个月内差异有统计学意义(P<0.001);RFA后3个月、6个月差异有统计学意义(P=0.033,P=0.001);RFA后1个月差异无统计学意义(P=0.123)。CUN组最大径与RFA近期疗效的ROC曲线分析,最佳截断值为2.95cm,此截断值曲线下面积(AUC)为0.90,敏感度92.3%,特异度84.0%。结论 CEUS在常规超声阴性RHCC射频消融治疗中能准确定位、精确引导,尤其是最大径≤3 cm病灶。>3 cm的病灶,需采用多电极RFA,受强化时间所限,布针精确度下降,不易保证各消融区之间达到有效重叠消融。术后定期复查以及时发现复发残留灶,发现越早治疗效果越理想。
Objective To investigate the short-term curative effect of radiofrequency ablation （RFA） in patients with conventional ultrasound negative （CUN）recurrent hepatocellular carcinoma （RHCC） under Contrast- enhanced ultrasound （CEUS）. Methods Between January 2013 and March 2017, conventional ultrasound negative RHCC patients in 108 cases of 113 lesions who underwent percutaneous transhepatic RFA guided by CEUS in our Hospital ultrasound department. All cases were characterized by Contrast-enhanced CT/MRI and detected by CEUS in the corresponding position. According to CEUS arterial phase to strengthen the maximum diameter of the group, the largest diameter ≤3 cm for the N1 group, 〉 3 cm for the N2 group. Conventional ultrasound positive （CUP） RHCC patients in 88 cases of 94 lesions who underwent percutaneous transhepatic RFA guided by conventional ultrasound were selected as the control group （CUP group）. All lesions were treated with RFA prior to CEUS examination. CEUS/CECT/MRI were reviewed at 1 month, 3 months and 6 months after RFA, and the short-term efficacy was evaluated after RFA. Results There was no significant difference in the efficacy of RFA between 1 month, 3 months and 6 months （P = 0.75, P = 0.85, P = 0.41 ） between CUN group and CUP group. Comparison of short-term curative effect between N 1 group and N2 group. There was significant difference within 6 months after RFA（P 〈 0.001 ）. There was significant difference at 3 months and 6 months after RFA （P = 0.033, P = 0.001 ）, and there was no significant difference at 1 months after RFA （P = 0.123）. Analysis of ROC curve of CUN group＇s maximum diameter and RFA short-term curative effect, the optimal cutoff value was 2.95 cm, and the area under the cutoff curve （AUC） was 0.90, the sensitivity was 92.3%, and the specificity was 84.0%. Condusion CEUS can accurately locate and guide, especially at which the maximal diameter 3cm lesions inconventional ultrasound negative RHCC radiofrequency ablation. The les
出处
《实用医学杂志》
CAS
北大核心
2018年第3期401-405,共5页
The Journal of Practical Medicine
基金
河南省科技厅资助项目(编号:142102310412)
关键词
肝细胞性肝癌
复发
超声造影
射频消融
hepatocellular carcinoma
recurrence
contrast- enhanced ultrasound
radiofrequency ablation
