三维可视化辅助经皮微波消融治疗复发性肝癌价值分析

Analysis of recurrent hepatocellular carcinoma treated by microwave ablation assisted by three-dimensional visualization

目的评价三维可视化辅助经皮微波消融治疗复发性肝癌的临床效果。方法选择2017-12-01至2019-06-01中国人民解放军总医院介入超声科连续收治的经皮微波消融的84例复发性肝癌病人,根据是否进行三维可视化评估分为三维重建组(30例,49个病灶)和常规组(54例,111个病灶)。比较两组病人治疗相关指标及预后情况。用三维可视化软件计算术前全肝体积、肿瘤体积、预计消融体积、术后全肝体积、消融体积,并对比术前规划消融体积与术后实际消融体积。结果所有病人均完成经皮微波消融治疗,肿瘤最大径为(4.3±1.0)cm。随访时间为10(2~19)个月。三维重建组和常规组严重并发症发生率(6.7%vs. 9.3%)、总存活率(100%vs.94.4%)、肝内复发率(8.2%vs. 12.6%)及局部复发率(6.1%vs. 10.8%)差异无统计学意义(P>0.05)。三维重建组病人术前规划体积和消融体积差异无统计学意义(P=0.616),消融后剩余肝体积与标准肝体积的比值为98.0%±25.6%。两组病人微波消融前后的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素、胆碱酯酶差异无统计学意义(P>0.05)。结论三维可视化辅助经皮微波消融在复发性肝癌的精准治疗中有重要的价值。

Objective To evaluate the clinical efficiency and feasibility for the treatment of recurrent hepatocellularcarcinoma treated by percutaneous microwave ablation assisted by three-dimensional visualization.Methods Theclinical data of 84 consecutive patients with recurrent hepatocellular carcinoma treated by percutaneous microwaveablation in Department of Interventional Ultrasonography,Chinese PLA General Hospital from December 1,2017 to June1,2019 were analyzed retrospectively.The patients were divided into three-dimensional reconstruction group(30 patients,49 tumors)and normal group(54 patients,111 tumors)according to whether evaluated by three-dimensionalvisualization.Treatment related indicators and the prognosis were compared.Preoperative total liver volume,tumorvolume,planning ablation volume,postoperative total liver volume and ablation volume were computed via three-dimensional visualization system in three-dimensional reconstruction group.Furthermore,the preoperative planningablation volume and actual postoperative ablation volume were compared between the two group.Results All patientsaccomplished the procedure of percutaneous microwave ablation.The maximal diameter of tumor was(4.3±1.0)cm,andthe follow-up period was 10(2-19)months.The three-dimensional reconstruction group and normal group had nosignificant differences in major complications rate(6.7%vs.9.3%),overall survival rate(100%vs.94.4%),intrahepaticdistant recurrence rate(8.2%vs.12.6%)and local tumor progression rate(6.1%vs.10.8%)(P>0.05).There was nostatistically significant difference between preoperative planning ablation volume and postoperative ablation volume inthe two groups(P=0.616).The ratio of residual liver volume/standard liver volume was(98.0±25.6)%.Alanine aminotransferase,aspartate amino transferase,total bilirubin and cholinesterase had no statistically significant difference before and after ablation between two groups(P>0.05).Conclusion The role of ultrasound-guidedpercutaneous microwave ablation assisted by three-dimensional visualization for the accurate treatment of recurrent hepatocellular carcinoma is of great importance.