术中超声检查在肝脏肿瘤手术中应用的临床意义

The Clinical Signification of IOUS during the Liver Tumor Operation

目的探讨术中超声((intraoperative ultrasound,IOUS)检查在肝脏肿瘤手术的临床意义。方法对53例(89个结节)肝脏肿瘤患者的术中超声检查结果与术前影像学检查(包括体外经皮超声(ultrasonography,US)、核磁共振成像(magnetic res-onance imaging,MRI)和计算机断层扫描(computed tomography,CT))进行对比分析,以评价术中超声与术前影像学检查的差异;将术中超声检查与术中外科医生评定(包括肉眼观察、双手触诊)进行对比分析,以评价术中超声在外科手术过程中的作用。结果在肝脏肿瘤的探查中I,OUS、US、CT、MRI的敏感性分别为100%(89/89个结节)、81%(72/89个结节)、82%(49/60个结节)和87%(40/46个结节),特异性分别为91%(81/89个结节)、89%(64/72个结节)、90%(44/49个结节)和93%(37/40个结节)。在外科手术过程中,外科医生经望诊、触诊不能发现病灶,而由术中超声检查发现并定位的患者有11例,15个结节(17%,15/89个结节)。术前所有影像学检查未能提示结节,而由术中超声检查发现的患者有8例,11个结节。结论IOUS是检查发现肝脏肿瘤最敏感的方法,在手术过程中,可帮助外科医生发现触及不到的已知结节和发现新结节。

Objective The purpose of the study was to evaluate the clinical impact of intraoperative ultrasound （IOUS） on the patients with liver neoplasm. Methods The examination results of IOUS were comparably researched with preoperative imaging examinations （ultrasonography（US）, magnetic resonance imaging（MRI）and computed tomography（CT）） on 53 patients（89 tumors）with liver tumors, in order to study their difference. And the comparing study was also made between the IOUS and the surgeon assess（including naked eye observed and both hands touch ）,to appraise IOUS effect during the operation. Results In the exploration of the liver tumors, the sensitivity of IOUS,US,CT,MRI were separately shown 100% （89/89tumors）, 81% （72/89tumors）, 82% （49/60tumors）and 87 % （40/46tumors）and the specificity were separately shown 91% （81/89turfiors）, 89% （64/72tumors）, 90% （44/49tumors）and 93 % （37/40tumors）. During the operation, there were 11 patients ,15 tumors （17%, 15/89tumors） which surgeon did not find by palpating and looking over could be found and orientated by IOUS. 8 patients, 11 tumors, which did not be shown on the all of preoperative imaging examinations, were found on IOCS. Conclusion IOUS was the most sensitive method at finding out liver tumors. During the operation, IOUS could help surgery to discover the new but not palpable tumors and find new tumors.