三维可视化术前规划系统辅助超声引导微波消融联合肝动脉化疗栓塞治疗大肝癌效果的初步研究

Ultrasound-guided percutaneous microwave ablation assisted by three-dimensional planning system combined with transhepatic arterial chemoembolization for treating single large hepatocellular carcinoma:a primary study of survival

目的评估三维可视化术前规划系统辅助超声引导下,经皮穿刺肝内病灶微波消融治疗直径大于5 cm的单病灶原发性肝细胞肝癌的安全性及临床应用价值。方法选取2015年5月至2017年8月在解放军总医院介入超声科接受微波消融治疗的40例患者,这些患者病灶均为单发大于5 cm原发性肝细胞肝癌,其中21例接受无三维术前规划的常规超声引导下经皮穿刺肝内病灶微波消融治疗,19例接受三维可视化术前规划辅助超声引导下肝内病灶微波消融治疗,采用Kaplan-Meier及Log-rank检验比较2组间有无复发生存及总生存的差异。结果三维术前规划组和无三维术前规划组1、3年总生存率分别为94.7%、38.5%,100.0%、34.4%,差异无统计学意义(P=0.745);1、3年无进展生存率分别为100.0%、64.6%,89.5%、18.8%,差异有统计学意义(χ2=1.210,P=0.014)。两组患者均未出现消融相关严重并发症及死亡。结论三维可视化术前规划辅助超声引导下肝内病灶微波消融治疗大于5 cm原发性肝癌可提高消融治疗的无肿瘤进展生存率,并表现出较好的安全性,将为消融治疗提供新的辅助手段,为进一步智能消融治疗打下基础。

Objective To evaluate the safety and clinical efficacy of three-dimensional(3D)visualization preoperative planning system assisted ultrasound-guided percutaneous microwave ablation for treating single large hepatocellular carcinoma(HCC).Methods Forty patients with a single large HCC(diameter≥5 cm)from May 2015 to August 2017 were included,of whom 21 received ultrasound-guided percutaneous microwave ablation without 3D visualization assistance and 19 patients were treated under the assistance of 3D visualization.Survival and recurrence were recorded and compared between the two groups.Results The 1-year and 3-year overall survival rates of the 3D visualization group and no 3D visualization group were 94.7%and 38.5%,and 100%and 34.4%,respectively,which showed no statistical difference(P=0.745).The 1-year and 3-year recurrence free survival rates of the two groups were 100%and 64.6%,and 89.5%and 18.8%,respectively,which showed statistical differences(P=0.014).No severe complication or death occurred in either group.Conclusion 3D visualization assisted ultrasound guided microwave ablation for primary liver cancer larger than 5 cm can improve the recurrence free survival rate and demonstrate good safety,thus providing a new auxiliary method for ablation and laying a foundation for intelligent ablation.