术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值

Diagnostic value of preoperative and intraoperative contrast-enhanced ultrasound in differentiating bland from inferior vena cava tumor thrombus

目的探讨术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值。方法选取2017年10月至2019年3月解放军总医院收治的发现肾肿瘤伴下腔静脉癌栓并行腹腔镜手术治疗的患者60例,所有患者均于术前及术中行超声造影检查,以典型增强模式判断癌栓是否合并血栓,并最终取得术后病理结果。以术后病理结果为“金标准”,计算术前及术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值和阴性预测值。结果60例下腔静脉癌栓患者均接受了机器人辅助腹腔镜下根治性肾切除联合下腔静脉内癌栓切除术。根据病理结果,下腔静脉癌栓合并血栓者10例(16.7%),其中术前超声造影漏诊2例,另有2例癌栓头部坏死组织被术前及术中超声造影误诊为血栓。术前与术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为80.0%、96.0%、93.3%、80.0%、96.0%和100.0%、96.0%、96.7%、83.3%、100.0%。结论术前及术中超声造影对下腔静脉癌栓是否合并血栓有较好的鉴别诊断效能,可为手术方式的选择提供重要信息和依据,具有较高的临床应用价值。

Objective To evaluate the diagnostic value of preoperative and intraoperative contrast-enhanced ultrasound(CEUS)in differentiating bland from inferior vena cava tumor thrombus.Methods From October 2017 to March 2019,60 cases of renal tumor who had inferior vena cava tumor thrombus and underwent laparoscopic surgery were selected.All patients underwent contrast-enhanced ultrasound before and during the operation to determine whether the tumor thrombus was combined with bland thrombus in typical enhancement mode,and postoperative pathological results were finally obtained.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of preoperative and intraoperative contrast-enhanced ultrasound were statistically analyzed.Results All 60 patients with IVC tumor thrombus underwent robot-assisted laparoscopic radical nephrectomy and IVC thrombectomy.The tumor thrombus was accompanied by bland thrombus in ten cases.Two cases of bland thrombus were missed by preoperative contrast-enhanced ultrasound,and the necrotic tissues in the head of tumor thrombus in another two cases were misdiagnosed as bland thrombus by both pre-and intra-operative CEUS.The sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of preoperative CEUS in differentiating bland thrombus from tumor thrombus were 80.0%,96.0%,93.3%,80.0%,and 96.0%,respectively;the corresponding values of intraoperative CEUS were 100.0%,96.0%,96.7,83.3%,and 100.0%.Conclusion Preoperative and intraoperative contrast-enhanced ultrasound performs well in the differential diagnosis of inferior vena cava tumor thrombus from bland thrombus,and it can provide important information and basis for the choice of operation mode,which is highly valuable in clinical application.