常规灰阶超声无法显示小肝癌射频消融的研究

A study on radiofrequency ablation of small liver cancer that conventional grayscale ultrasound cannot display

目的:探讨肝硬化背景下常规二维灰阶超声无法显示小肝癌(SHCC)射频消融(RFA)治疗的时间切入点以及早期治疗的临床意义。方法:选取经RFA治疗262例(357个结节)SHCC,根据常规超声可否显示分为两组:无法显示组(试验组)、可显示组(对照组),无法显示组为经MRI、CT发现的SHCC,由于肝硬化背景常规超声无法探及病灶位置及边界,RFA治疗经超声造影定位。比较两组并发症发生率、完全消融率、肝内复发率、无瘤生存率、总生存期,分析试验组预后危险因素。结果:与对照组相比,试验组肝内远处复发(IDR)发生率、肝内总复发率较低,差异有统计学意义(P<0.05),肿瘤局部进展(LTP)发生率差异无统计学意义(P=0.440)。与对照组相比,试验组12个月、24个月、36个月、48个月、60个月无IDR生存率较高,差异有统计学意义(P=0.021),累计无瘤生存率较高,差异有统计学意义(P=0.020)。无LTP生存率差异无统计学意义(P=0.328)。两组完全消融率及术后并发症的发生率差异无统计学意义(P>0.05)。多因素分析提示安全边界的建立与术后试验组IDR的发生密切相关。结论:对于肝硬化背景下SHCC,与常规超声可显示SHCC相比,无法显示的SHCC术后IDR发生率较低,累积无瘤生存率较高,因此应对此类常规超声无法显示SHCC及时进行射频治疗。

Objective To investigate the treatment strategies and long-termoutcomes of radiofrequency ablation(RFA)on small hepatocellular carcinoma(SHCC)which conventional two-dimensional gray-scale ultrasound can't show under the background of liver cirrhosis.Method 262 patients(357 nodules)with SHCC who received RFA were screened,these patients were divided into conventional ultrasound can't show group(experimental group)and conventional ultrasound can show group(control group).Conventional ultrasound can't show group was conventional ultrasound can't detect the location and boundary of SHCC which detected by MRI or CT,RFA guided by contrast-enhanced ultrasound or image fusion technology.Complete ablation rates,intrahepatic recurrence rates,disease-free survival(DFS)rates and complication rates were compared between the two groups and analyze prognostic factors of the experimental group.Results There was a significant difference in Intrahepatic distal recurrence(IDR)rates and total recurrence rates between the experimental group and control group(P<0.05).However,the Local tumor progression(LTP)rates in the experimental group was not significantly different from the control group(P=0.440).The 1-,2-,3-,4-,and 5-year IDR-free survival rates and DFS rates were significantly higher in the experimental group compared with the control group(P=0.021),the cumulative tumor free survival rate was relatively high(P=0.020).There was no statistically significant difference in LTP free survival rate(P=0.328).Complete ablation rates and complication rates between two groups has no statistically significant difference(P>0.05).Multivariate analysis identified ablative margin was associated with IDR in experimental group.Conclusion For SHCC under the background of liver cirrhosis,conventional ultrasound can't show SHCC has a lower IDR and higher DFS rates compared with the conventional ultrasound can show SHCC,so we should early detect and treatment these conventional ultrasound can't show SHCC.