超声引导下PRFA治疗非手术适应症肝癌术后的肿瘤影像表现与疗效的关系

Relationship between postoperative imaging findings and therapeutic effect in patients with unresectable hepatocellular carcinoma after ultrasound-guided percutaneous radiofrequency ablation

目的:探讨射频消融术(percutaneous radiofrequency ablation,PRFA)后超声影像学表现与生化指标、复发率的关系.方法:选取PRFA患者36例,分析并比较其术前、术后7、14、28 d的谷丙转氨酶(alanine aminotrans-ferase,ALT)、谷草转氨酶(aspartate aminotrans-ferase,AST)、总胆红素(total bilirubin,TBIL),白蛋白(albumin,ALB),甲胎蛋白(alpha fetal protein,AFP)水平及超声和核磁共振(magnetic resonance imaging,MRI)的影像学表现.结果:PRFA患者术后7 d ALT、AST均较术前明显升高(102.21 U/L±53.41 U/Lvs 55.34 U/L±36.57 U/L,90.58 U/L±37.22 U/L vs 65.77U/L±40.29 U/L),14 d后降至术前水平.血清AFP值转阴及AFP值下降≥50%者同期MRI显示肿瘤完全消融,超声显示病灶回声增强,病灶出现中央液化,内部无血流.血清AFP值升高者同期MRI显示肿瘤不完全消融,超声显示病灶部分回声增强,内见点状血流.以肿瘤标志物AFP水平为参考指标,PRFA的有效率≥60%.PRFA患者的术后3年生存率68%,中位生存时间38.09 mo.结论:PRFA术后患者影像学表现与生化指标、肿瘤复发相一致.影像检查可作为检测肿瘤复发的一种有效手段.

AIM： To investigate the relationship between postoperative imaging findings and therapeutic effect in patients with unresectable hepatocellu- lar carcinoma after ultrasound-guided percuta- neous radiofrequency ablation （PRFA）. METHODS： Thirty-six patients with unresect- able hepatocellular carcinoma who undersent ultrasound-guided percutaneous radiofrequency ablation were selected. The levels of alanine aminotransferase （ALT）, aspartate aminotrans- ferase （AST）, total bilirubin （TBIL）, albumin （ALB）, and alpha fetal protein （AFP） as well asimaging findings were retrospectively analyzed （1 day before, 7, 14 and 28 d after PRFA）. RESULTS： The levels of ALT and AST were sig- nificantly higher on day 7 after PRFA than on day 1 before PRFA （102.21 U/L ± 53.41 U/L vs 55.34 U/L ± 36.57 U/L, 90.58 U/L ±37.22 U/L vs 65.77 U/L ± 40.29 U/L）, and they decreased to preop- erative levels on day 14. Patients with an AFP level decreased by ≥ 50% on day 28 showed complete ablation of the tumors on magnetic resonance imaging （MRI） and high echo area with liquefac- tion and no blood flow in the center of the lesions on ultrasound. Patients with elevated AFP values showed incomplete ablation of the tumors on MRI and incomplete high echo area with blood flow on ultrasound. The effective rate of PRFA was higher than 60% when the levels of AFP were used as evaluation criterion. The 3-year survival rate was 68%. The median survival time was 38.09 mo. CONCLUSION： The imaging findings can well reflect the changes of serum markers and recur- rence in patients with unresectable hepatocellular carcinoma after ultrasound-guided percutaneous radiofrequency ablation. Imaging examinations can be used as an effective approach for the de- tection of recurrence of hepatocellular carcinoma.