超声造影对肝癌微波消融疗效及短期预后评估的价值探讨

Discussion on the value of contrast-enhanced ultrasound in the efficacy of microwave ablation for liver cancer and its short-term prognostic evaluation

目的探讨超声造影对肝癌微波消融疗效及短期预后评估的临床价值。方法选取2018年1~10月在娄底市中心医院经病理证实的肝癌住院患者30例,其中男19例,女11例,所有患者均为单发病灶,术前收集患者的基本资料及相关临床资料,并比较常规超声与超声造影在显示肿瘤大小上的差异,术中应用超声造影引导微波消融,术后1周统计并发症,术后1个月时行超声造影,并结合AFP、增强CT判断微波消融效果,计算超声诊断准确率、误诊率、漏诊率、敏感性、特异性、阳性预测值、阴性预测值。术后1个月、3个月、6个月、12个月记录患者消融病灶的容积、缩瘤率、AFP值、无瘤生存率及总体生存率。结果术前超声造影所示肿瘤最大径、肿瘤容积明显高于术前常规超声,差异有统计学意义(P<0.05)。30例患者共30个肿瘤病灶中,超声造影判断肿瘤效果的诊断准确率93.3%,误诊率3.3%,漏诊率50.0%,敏感性50.0%,特异性96.4%,阳性预测值50.0%,阴性预测值96.4%。术后1个月、3个月、6个月、12个月肿瘤逐渐缩小,平均缩瘤率分别为(21±3)%、(40±4)%、(49±4)%、(63±6)%,AFP值逐渐降低;术后12个月时无瘤生存率90.0%,总体生存率100.0%。所有患者术后均未发生严重并发症,术后出血2例(6.7%),术后低热5例(16.7%),右上腹痛1例(3.3%)。结论超声造影评估肝癌微波消融疗效及短期预后价值肯定,值得临床推广应用。

Objective To explore the clinical value of contrast-enhanced ultrasound in the efficacy of microwave ablation for liver cancer and its short-term prognostic evaluation.Methods From January to October 2018,30 inpatients with pathologically confirmed liver cancer in Loudi Central Hospital were selected,including 19 males and 11 females.All patients were with single lesions.The patients'basic data and related clinical data were collected before surgery,and the difference between conventional ultrasound and contrast-enhanced ultrasound in showing tumor size was compared.Contrast-enhanced ultrasound guided microwave ablation was used during the operation,and complications were statistically analyzed one week after surgery.Contrast-enhanced ultrasound was carried out at one month after surgery.AFP and enhanced CT were combined to determine the effect of microwave ablation.The accuracy,misdiagnosis rate,rate of missed diagnosis,sensitivity,specificity,positive predictive value,and negative predictive value of ultrasound diagnosis were calculated,and the volume of ablation lesions,tumor reducing rate,AFP value,tumor-free survival rate,and overall survival rate were recorded at 1 month,3 months,6 months,and 12 months after surgery.Results The maximum tumor diameter and tumor volume shown by preoperative contrast-enhanced ultrasound were significantly higher than those shown by preoperative conventional ultrasound,and the differences were statistically significant(P<0.05).Among 30 patients with a total of 30 tumor lesions,the diagnostic accuracy of contrast-enhanced ultrasound to determine the tumor was 93.3%,misdiagnosis rate was 3.3%,missed diagnosis rate was 50.0%,sensitivity was 50.0%,specificity was 96.4%,positive predictive value was 50.0%,and negative predictive value was 96.4%.Tumors were gradually reduced at 1 month,3 months,6 months,and 12 months after surgery.The average tumor reducing rates were(21±3)%,(40±4)%,(49±4)%,and(63±6)%;AFP value was gradually decreased;at 12 months after surgery,the tumor-free survival rate was 90.0%,and the overall survival rate was 100.0%.No serious complications were seen in all patients after surgery.Postoperative bleeding was seen in 2 cases(6.7%),postoperative low fever was in 5 cases(16.7%),and right upper abdominal pain was in 1 case(3.3%).Conclusion Contrast-enhanced ultrasound has a significant effect on the evaluation of the efficacy of microwave ablation for liver cancer and the value of its short-term prognosis,which is worthy of clinical promotion and application.