高强度聚焦超声治疗原发性肝癌即时超声造影评价并指导补充治疗的疗效观察

Efficacy of high intensity focused ultrasound supplementary treatment evaluated and instructed hy immediate contrast-enhanced ultrasound for primary hepatic carcinoma

目的探讨高强度聚焦超声（HIFU）治疗原发性肝癌即时超声造影评价并指导补充治疗的临床应用价值。方法55例原发性肝细胞癌患者（68个病灶）随机分为A、B两组，其中A组30例（38个病灶）治疗前及治疗后10min进行超声造影检查，并对未完全灭活的病灶针对性地行HIFU补充治疗；B组25例（30个病灶）为对照组。观察治疗的安全性及治疗后两组患者临床症状、甲胎蛋白、影像学等各项指标的变化，并比较两组患者的远期疗效。结果HIFU治疗后即时超声造影发现A组19个病灶未完全灭活并补充治疗。全部患者均无严重并发症出现。治疗后A、B两组患者甲胎蛋白值下降率分别为86、7％（26／30）、64．0％（16／25）；肿瘤完全坏死率分别为97、3％（37／38）、60．0％（18／30）；半年、1年生存率分别为100％、90．0％和76．0％、68．0％；两组差异均具有统计学意义（P〈0.05）。结论HIFU治疗原发性肝癌即时超声造影评价并指导补充治疗有利于病灶的完全灭活，可以缓解症状，改善生活质量，延长生存期，具有较好的临床应用价值。

Objective To explore the value of clinical application of high intensity focused ultrasound （HIFU） supplementary treatment evaluated and instructed by immediate contrast-enhanced ultrasound for primary hepatic carcinoma. Methods Fifty-five cases （68 lesions） of hepatocellular carcinoma（HCC） were randomized into 2 groups,30 cases （38 lesions） in group A and 25 cases（30 lesions） in group B, Patients of group A were examined by contrast-enhanced ultrasound before and after therapy in 10 minutes. The lesions of incomplete deactivation were treated by HIFU in time. The treatment security and the therapeutic effects were observed by the clinical symptom,serum AFP and imaging appearance. The long-term therapeutic effects were judged by follow-up survival rate, Results Nineteen lesions in group A were found incomplete deactivation and run supplementary treatment in time. No serious complication was identified. The AFP descending rate was 86.7% （26/30） in group A,64.0% （16/25） in group B, respectively（P〈0.05）, and the lesions complete necrosis rate was 97.3 % （37/ 38） ,60.0% （18/30） ,respectively（P〈0.05）. Half year survival rate was 100% in group A,90.0% ih group B（ P 〈0.05）, and 1 year survival rate was 76.0%, 68.0%, respectively （ P 〈 0.05）. Conclusions HIFU supplementary treatment evaluated and instructed by immediate contrast-enhanced ultrasound for primary hepatic carcinoma can help to destroy the lesions completely, alleviate the symptom, reduce recurrence, improve life quality, lengthen the lifetime, and has the better clinical practice value.