三维医学影像技术辅助超声引导下穿刺注射平阳霉素治疗巨大肝血管瘤的应用价值

The value of three-dimensional medical imaging guided ultrasound in the treatment of huge hepatic hemangioma

目的评估三维医学影像辅助超声引导下穿刺注射平阳霉素治疗巨大肝血管瘤的应用价值。方法选择2013年2月至2014年12月河南省濮阳市中医医院收治的76例巨大肝血管瘤患者。所有患者分为二维常规治疗组与三维规划治疗组2组,每组各38例。二维常规治疗组患者接受常规CT检查,超声引导下注射平阳霉素治疗;治疗过程中,依据医师经验来确定穿刺针数及用药量。三维规划治疗组患者在接受常规CT检查后,将常规CT图像用解放军总医院自主研发的三维可视化软件进行三维重建和分析,规划穿刺路径,并依据规划,超声引导下注射平阳霉素治疗。采用配对t检验比较二维常规治疗组与三维规划治疗组患者肿瘤平均直径、穿刺注药次数、单个肿瘤治疗平均用药量;采用χ2检验比较二维常规治疗组与三维规划治疗组患者首次治疗成功率、不良反应发生率差异。结果 2组患者肿瘤平均直径差异无统计学意义。三维规划治疗组患者穿刺注药次数、单个肿瘤治疗平均用药量均低于二维常规治疗组患者[(6.2±0.5)次vs(9.3±0.6)次,(99.2±8.0)mgvs(148.8±9.6)mg],而首次治疗成功率高于二维常规治疗组患者[100%(38/38)vs 73.6%(28/38)],且差异均有统计学意义(t=24.467,P=0.035;t=34.613,P=0.029;χ2=131.91,P=0.032)。三维规划治疗组患者不良反应发生率低于二维常规治疗组患者[15.8%(6/38)vs 57.9%(22/38)],且差异有统计学意义(χ2=38.849,P<0.05)。结论在三维医学影像技术辅助下,可减少超声引导下介入治疗单个巨大肝血管瘤的穿刺次数及用药总量,提高首次治疗成功率,达到较好的治疗效果。

Objective To evaluate the clinical application value of three-dimensional medical image guided ultrasound in the chemotherapy of huge hepatic hemangioma. Methods Seventy-six cases were enrolled in a randomized control study. All cases were randomly divided into two groups（group A and group B）. In group A, all cases underwent treatment based on the traditional two-dimensional medical images. Under the assistance of three-dimensional medical image information, preoperative treatment planning was performed in group B. After puncture treatment, therapeutic efficacy was evaluated by color ultrasound during follow-up. Results For treating huge hepatic hemangioma（tumor diameter ≥ 10.0 cm）, the insertion number and pingyangmycin dosage in the group B were less than those in the group A [（6.2±0.5） times vs（9.3±0.6） times, t=24.467, P=0.035;（99.2±8.0） mg vs（148.8±9.6） mg, t=34.613, P=0.029]. The success rate of first treatment in the group B was higher than that in group A [73.6%（28/38） vs 100%（38/38）, χ^2=131.91, P=0.032]. Conclusion For huge hepatic hemangioma, the three-dimensional medical image information can be applied to reduce the insertion number and anesthetics dosage, improving the success rate of first treatment and therapeutic effect.