超声在^(125)I粒子植入肝脏恶性肿瘤的应用价值

The value of tomographic ultrasound imaging in 125I seeds implantation in the treatment of liver malignant tumors

目的探讨超声在125I粒子植入肝脏恶性肿瘤的应用价值。方法 16例肝癌患者的24个病灶125I粒子植入肿瘤前采用PhilipsIU-22超声诊断仪、三维容积成像技术和QLab软件对病灶进行超声断层显像检查,模拟粒子空间排布,计算所需植入粒子数。植入时超声监测经皮经肝沿超声穿刺引导线放置粒子,术后应用超声造影剂SonoVue和超声容积成像计算肿瘤的局部控制率,描绘残留肿瘤的几何形态。结果断层超声显像技术术前能科学合理的绘制粒子分布图,准确计算粒子数,简化术中操作,肿瘤局部控制率与文献报道无明显差异。术中超声导向能动态观察植入针尖位置,避开血管、胆管等重要结构,减少并发症,准确将粒子植入预期位置。术后应用超声造影容积成像准确定量评估125I粒子治疗恶性肿瘤的疗效,与增强CT检查无明显差异,结合描绘残余病灶的三维几何形态利于对其粒子补充治疗。结论超声在125I粒子植入肝脏恶性肿瘤术前、术中及术后均有重要的临床价值。

Objective To determine the value of tomographic ultrasound imaging（TUI） in ^125I seeds implantation in the treatment of liver malignant tumors. Methods In 24 lesions of 16 patients of liver cancer,Phillips IU-22 diasonography,3D volume imaging techniques,QLab software were used to make plan of simulating spatial arrangement of seeds and to calculate quantity of seeds before operation. Ultrasound was used for guidance in ^125I seeds implantation. Local control rate was calculated by Sono Vue contrast-enhanced ultrasound and volume imaging techniques,and geometric shape of tumor residual was delineated. Results TUI can scientifi cally and rationally delineate the profi le of seeds,accurately calculate of seeds and simplify the operation process. The tumor control rate was similar to literature report. The needle tip can be observed dynamically and seeds can be implanted exactly in expecting position without vessel and bile duct injury,so complications were reduced. After operation,ultrasound can be used for evaluating the effect of 125I seeds implantation by contrast-enhanced ultrasound and volume imaging techniques. It was similar to contrast-enhanced CT. Supplementary seeds implantation can be made if there is tumor residual. Conclusion Ultrasound guidance is signifi cant to ^125I seeds implantation not only in operation but also in pre-and post-operation.