氩氦刀治疗肝肺恶性肿瘤中不同引导方式的影像学效果分析

Imaging findings and therapeutic efficacy of malignant hepatic and pulmonary tumors during cryosurgery with Argon-Helium knife under different guiding modes

目的探讨B超和CT两种引导方式在氩氦刀治疗肝肺恶性肿瘤中影像学的表现及价值。方法氩氦刀治疗恶性肿瘤患者35例,应用B超引导19例,应用CT引导16例,观察不同方式下的术中影像学表现及术中并发症的发生。结果B超引导下,术中5～10s后显示弧形强回声的冰球边缘,中心低回声区,后方伴声影,随着冷冻时间延长,强回声的边缘扩大,复温后强回声消失。CT引导冷冻完毕扫描显示以靶点为中心的低密度区。B超引导下,冷冻时发现出血4例,刺破胆管胆汁漏1例;CT引导下,冷冻完毕扫描发现气胸4例。结论两种引导方式都能清晰地显示消融靶区。选择哪种方式要考虑治疗的组织器官,便于发现术中并发症并及时处理。

Objective To explore the imaging findings and therapeutic efficacy of malignant hepatic and pulmonary tumors during cryosurgery with Argon - Helium knife under different guiding modes. Methods Thirty - five patients with pathologically proved malignant hepatic and pulmonary tomors underwent uhrasonography （US） or computed tomography （CT） guided Argon- Helium knife cryosurgery, in whom 19 cases were guided by US and 16 cases were guided by CT. Intraoperative imaging findings and complications were observed under above both guided modes. Resutls Under US guidance, in intratumoral ice ball with high - echo border and low - echo center area was observed at 5 - 6 seconds after the freezing, whose back associated sound shadows, with prolong of freezing time, high - echo border appeared enlargement and then disappeared after temperature recover. Under CT guidance, the center of target points appeared hypodense area after freezing. Under US guiding, 4 cases of hemorrhage were found during freezing and one case bile- leak due to bile tube rupture was found. Under CT guiding. 4 cases of pneumothorax were found after freezing. Conclusion The guiding modes of US and CT can clearly reveal the ablation area, while the selection of guiding modes needs consider the tissue and organ which undergo cryosurgery so as to find in- tracperative complioations and timely treat it.