超声造影引导下单极射频消融与无接触多极射频消融治疗肝肿瘤的对比研究

Comparative study of monopolar radiofrequency ablation and no-touch multipolar radiofrequency ablation in the treatment of liver tumors under the guidance of contrast-enhanced ultrasound

目的对比分析超声造影引导下单极射频消融(M-RFA)与无接触多极射频消融(No-touch RFA)治疗肝肿瘤的临床应用价值。方法回顾性分析在我院行超声造影引导下M-RFA和No-touch RFA治疗肝肿瘤的94例患者(M-RFA组44例,No-touch RFA组50例)的检查资料,比较两组患者术后病灶灭活范围和灭活率,以及治疗前后实验室检查指标的差异;随访24个月,观察患者的无瘤生存率。结果射频消融后,超声造影测量M-RFA组肿瘤灭活范围平均值为38.36 mm×31.31 mm,No-touch RFA组为46.70 mm×35.82 mm;M-RFA组完全灭活率为90.9%(40/44),No-touch RFA组为98.00%(49/50),差异有统计学意义(P<0.05)。M-RFA组21例患者甲胎蛋白阳性,RFA术后1个月9例明显下降,12例转阴;No-touch RFA组20例患者甲胎蛋白阳性,RFA术后1个月6例明显下降,14例转阴,两组术前术后比较差异均有统计学意义(均P<0.001)。术后随访24个月,M-RFA组无瘤生存率为47.72%(21/44),No-touch RFA组为68.00%(34/50),差异有统计学意义(P=0.041)。结论超声造影引导下No-touch RFA治疗肝肿瘤有助于提高肿瘤的灭活率,疗效显著,无瘤生存率高,较M-RFA临床应用价值更佳。

Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS)guided monopolar radiofrequency ablation(M-RFA)and no-touch multipole radiofrequency ablation(No-touch RFA)in the treatment of liver tumors.Methods A total of 94 cases of liver tumors patients treated with M-RFA and No-touch RFA under the guidance of real-time CEUS in our hospital were enrolled,including 44 cases of M-RFA group and 50 cases of No-touch RFA group.The postoperative lesion inactivation range,inactivation rate and lab examination indexes before and after treatment were compared.The patients were followed up regularly for 24 months and the tumor-free survival rate was recorded.Results After treatment,the average inactivation range of the M-RFA group and the No-touch RFA group by CEUS were 38.36 mm×31.31 mm and 46.70 mm×35.82 mm,respectively.The total inactivation rate of the M-RFA group and the No-touch RFA group were 90.9%(40/44)and 98.00%(49/50),respectively.The difference was statistically significant(P<0.05).After treatment,21 AFP positive patients in the M-RFA group,12 cases were transferred into negative AFP and serum AFP level in 9 cases decreased significantly 1 month after treatment.20 AFP positive patients in the No-touch RFA group,14 cases were transferred into negative AFP and serum AFP level in 6 cases decreased significantly 1 month after treatment.The difference of preoperative and postoperative AFP levels between the two groups were statistically significant(both P<0.05).Regular follow-up to 24 months after treatment showed that the tumor-free survival rate was 47.72%(21/44)in the M-RFA group and 68.00%(34/50)in the No-touch RFA group,and the difference was statistically significant(P=0.041).Conclusion CEUS guided No-touch RFA treatment of liver tumors is helpful to improve the tumor inactivation rate with significant efficacy and high tumor-free survival rate,which has better application value than M-RFA.