实时超声造影与3D超声融合成像导航评估微波消融治疗原发性肝癌患者价值研究

Guidance of real-time contrast-enhanced ultrasonography and 3D ultrasound fusion imaging for ablation area in patients with primary liver cancer during microwave ablation therapy

目的探讨采用实时超声造影与3D超声融合成像导航评估微波消融(MWA)治疗原发性肝癌(PLC)患者的疗效。方法2017年2月~2021年2月梅州市人民医院收治的102例PLC患者,被随机分为观察组51例和对照组51例,两组均行MVA术治疗,其中对照组术中采用常规超声造影评估消融范围,在观察组采用实时超声造影联合3D超声融合成像导航评估。随访1年,记录两组总体生存率。结果观察组完全消融率和补充消融率分别为94.1%和19.6%,显著高于对照组的78.4%和3.9%(P<0.05);术后,观察组发生出血、切口感染、周围脏器损伤、胆漏和胸腹腔积液发生率为17.7%,与对照组的21.6%比,差异无统计学意义(P>0.05);随访1年,观察组肝内肿瘤复发率为10.0%,显著低于对照组的28.0%(x^(2)=5.26,P=0.02);观察组1 a总体生存率为96.0%,而对照组为84.0%(Log-Rank x^(2)=22.159,P<0.001)。结论采用实时超声造影联合3D超声融合成像导航可用于评估MWA治疗PLC患者术中消融范围,对及时补充消融有帮助,并最终提高疗效。

Objective The aim of this study was to investigate the guidance of real-time contrast-enhanced ultrasonography and 3D ultrasound fusion imaging for ablation area in patients with primary liver cancer(PLC)during microwave ablation(MWA)therapy.Methods A total of 102 patients with PLC were encountered in Meizhou People's Hospital between February 2017 and February 2021,and were randomly divided into observation(n=51)and control group(n=51).They were all treated with MVA.In the control group,the conventional contrast-enhanced ultrasonography was applied to evaluate the ablation area,while in the observation group was evaluated by real-time contrast-enhanced ultrasonography and 3D ultrasound fusion imaging navigation combination.All patients were followed-up for one year,and the one-year overall survival rate in the two groups were recorded and compared.Results The complete ablation rate and supplemental ablation rate in the observation group were 94.1%and 19.6%,significantly higher than 78.4%and 3.9%in the control(P<0.05);after MWA,theincidence of ablation-related complications,such as bleeding,infection,adjacent organ injuries,bile leakage and pleural effusion or ascites in the observation was 17.7%,not significantly different compared to 21.6%in the control(P>0.05);at the end of one-year follow-up,therecurrence of intrahepatic tumor in the observation was 10.0%,significantly lower than 28.0%in the control group(x^(2)=5.26,P=0.02);the one-year overall survival rate in the observation was 96.0%,significantly higher than 84.0%(Log-Rank x^(2)=22.159,P<0.001)in the control.Conclusion The guidance of ablation area by real-time contrast-enhanced ultrasonography and 3D ultrasound fusion imaging navigation combination could help evaluate the ablation efficacy of MWA in patients with PLC,and warrants further clinical investigation.