术中超声在冷循环射频治疗肿瘤中的应用

Application of intraoperative ultrasound in radiofrequency ablation with cool-tip electrodes for carcinoma

目的探讨术中超声(IOUS)在冷循环射频治疗肿瘤中的临床应用价值。方法48例肝癌患者,5例胰体尾癌患者。将术中探头直接置于脏器表面,首先观察肿瘤的部位、大小、数量和周围血管的毗邻关系,取活检后在超声引导下将射频电极针穿刺入肿瘤内部,多点分次进行治疗。结果53例患者全部在超声引导下完成治疗。5例患者经术中超声检查发现新病灶。术中观察到治疗后肿瘤颜色变暗,瘤体变瘪凹陷,声像图上肿瘤呈高回声改变。术后随访2～12个月,46例存活。结论开腹下应用术中超声引导冷循环射频治疗,定位准确,安全性高,可多点多次对肿瘤进行射频灭活,坏死区域大。并且术中超声能够弥补术前影像学的不足,发现术前漏诊的病灶而使患者及时得到治疗。

Objective To study the value of the clinical application of intraoperative ultrasound (IOUS) with cool-tip radiofrequency(RF) in carcinoma. Methods Intraoperative ultrasonography was applied in 48 patients with hepatic tumor and 5 patients with pancreatic tumor. Intraoperative probe was put on the surface of the viscera directly,and the location,volume,number and adjoining vessels of tumors were observe. After the biopsy,the radiofrequency electrode was placed into tumor under the guidance of IOUS,then the multi-stage and multi-point treatment were performed. Results All of the 53 patients completed their therapies under the guidance of IOUS,and new focus were found by IOUS in 5 cases. Forty-six patients survived in 2 ～ 12 months in following up after treatment. Conclusion The application of laparotomic cool-tip RF under guidance of IOUS has the advantages of accurate locallization,safty and multistage and multipoint inactivation of the tumor tissue with lager necrotic area. Furthermore the intraoperative ultrasound could compensate the disadvantages of preoperational imaging,discover the misdiagnostic focus and result in treatment in time.