腹腔镜超声造影在肝细胞癌伴肝硬化患者腹腔镜手术中的应用

Application of laparoscopic contrast enhanced ultrasound in laparoscopic surgery for hepatocellular carcinoma combined with cirrhosis

目的探讨腹腔镜超声造影在肝细胞癌(HCC)伴肝硬化患者腹腔镜手术中的应用价值。方法回顾性分析2018年2月至2020年2月华中科技大学同济医学院附属同济医院71例肝细胞癌伴肝硬化患者的临床资料。患者术前行增强CT和多参数MRI检查,行腹腔镜下肝部分切除术治疗,术中行腹腔镜超声造影检查。根据组织学检查和随访结果,比较术前影像与术前影像联合术中腹腔镜超声造影对肝细胞癌伴肝硬化患者肝脏恶性病灶的诊断效能。结果71例患者中,完成腹腔镜手术69例,中转开腹手术2例。术前影像学检查诊断HCC病灶110个,其中术中超声检出105个,术中腹腔镜超声造影诊断HCC病灶98个;术前影像与术前影像联合术中超声造影诊断肝脏恶性病灶的灵敏度、特异度、准确率、阳性预测值和阴性预测值比较差异无统计学意义[94.4%(102/108)比99.1%(107/108)、81.0%(34/42)比66.7%(28/42)、90.6%(136/150)比90.0%(135/150)、92.7%(102/110)比88.4%(107/121)和85.0%(34/40)比96.6%(28/29),P>0.05]。术中腹腔镜超声造影新发现的11个可疑恶性病灶中5个组织学证实为HCC。改变手术策略7例。结论HCC伴肝硬化患者在腹腔镜手术中行腹腔镜超声造影可对病灶全面检出、鉴别定性、精准定位、修正手术方案。

Objective To explore the application value of laparoscopic contrast enhanced ultrasound in laparoscopic surgery for patients with hepatocellular carcinoma combined with cirrhosis.Methods The clinical data of 71 patients with hepatocellular carcinoma combined cirrhosis from February 2018 to February 2020 in Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were retrospectively analyzed.The patients underwent preoperative enhanced CT and multi-parameter MRI examination,followed by laparoscopic partial hepatectomy,and intraoperative laparoscopic contrast enhanced ultrasound examination.Based on histological examination and follow-up results,the diagnostic efficacy of preoperative imaging and preoperative imaging combined with intraoperative laparoscopic contrast enhanced ultrasound in patients with hepatocellular carcinoma combined with cirrhosis was compared.Results Among the 71 patients,69 completed laparoscopic surgery and 2 converted to open surgery.One hundred and ten HCC lesions were diagnosed by preoperative imaging examination,105 lesions were detected by intraoperative ultrasound among them,of which 98 lesions were diagnosed as HCC by intraoperative laparoscopic contrast enhanced ultrasound.There were no statistically significant difference in sensitivity,specificity,accuracy,positive predictive value and negative predictive value between preoperative imaging and preoperative imaging combined with intraoperative laparoscopic contrast enhanced ultrasound in the diagnosis of malignant liver lesions:94.4%(102/108)vs.99.1%(107/108),81.0%(34/42)vs.66.7%(28/42),90.6%(136/150)vs.90.0%(135/150),92.7%(102/110)vs.88.4%(107/121)and 85.0%(34/40)vs.96.6%(28/29),P>0.05.Laparoscopic contrast enhanced ultrasound revealed an additional 11 suspected malignant lesions,of which 5 lesions were histologically confirmed as HCC.Seven patients underwent surgical strategy changes.Conclusions Laparoscopic contrast enhanced ultrasound in patients with HCC combined with cirrhosis during laparoscopic surgery can be used to detect,identify,accurately locate of the lesions and modify the surgical plan.