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*

doi:10.3969/j.issn.1672-5069.2022.06.033

实用肝脏病杂志 ›› 2022, Vol. 25 ›› Issue (6): 889-892.doi: 10.3969/j.issn.1672-5069.2022.06.033

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^*

蓝思荣, 徐继威, 张耀明, 李雄, 沈登文, 苏鸿辉

514031 广东省梅州市人民医院超声二科(蓝思荣,李雄,沈登文);肝胆一科(徐继威);肝胆二科(张耀明);汕头大学医学院第二附属医院超声介入科(苏鸿辉)

收稿日期:2022-03-04 出版日期:2022-11-10 发布日期:2022-11-22
通讯作者: 苏鸿辉,E-mail:suhui8112@163.com
作者简介:蓝思荣,男,41岁,大学本科,副主任医师。研究方向:介入超声诊治研究。E-mail:htyy2022@163.com
基金资助:
^*梅州市人民医院科研培育项目(编号:PY-C-2021014)

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

Lan Sirong, Xu Jiwei, Zhang Yaoming, et al.

Second Department of Ultrasound, People's Hospital,Meizhou 514031,Guangdong Province, China

Received:2022-03-04 Online:2022-11-10 Published:2022-11-22

摘要/Abstract

摘要： 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%(x²=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 x²=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。

关键词: 原发性肝癌, 微波消融, 实时超声造影, 3D超声融合成像导航, 治疗

Abstract: 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 (x²=5.26, P=0.02); the one-year overall survival rate in the observation was 96.0%,significantly higher than 84.0%(Log-Rank x²=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.

Key words: Hepatoma, Microwave ablation, Real-time contrast-enhanced ultrasonography, 3D ultrasound fusion imaging navigation, Therapy

蓝思荣, 徐继威, 张耀明, 李雄, 沈登文, 苏鸿辉. 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^*[J]. 实用肝脏病杂志, 2022, 25(6): 889-892.

Lan Sirong, Xu Jiwei, Zhang Yaoming, et al.. 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[J]. Journal of Practical Hepatology, 2022, 25(6): 889-892.

参考文献

[1] Xu X L, Liu X D, Liang M, et al. Radiofrequencyablation versus hepatic resection for small hepatocellular carcinoma: systematic review of randomized controlled trials with meta-analysis and trial sequential analysis. Radiology,2018,287(2):461-472.
[2] Puijk R S, Ruarus A H, Vroomen L, et al. Colorectalliver metastases: surgery versus thermal ablation (COLLISION) - a phase III single-blind prospective randomized controlled trial. BMC Cancer,2018,18(1):821.
[3] Lee K F, Wong J, Hui J W, et al. Long-term outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma by surgical approach: a retrospective comparative study. Asian J Surg,2017,40(4):301-308.
[4] An C, Li W Z, Huang Z M, et al. Small single perivascular hepatocellular carcinoma: comparisons of radiofrequency ablation and microwave ablation by using propensity score analysis. Eur Radiol,2021,31(7):4764-4773.
[5] Feng Y, Wang L, Lyu H, et al. Microwave ablation versus radiofrequency ablation forperivascular hepatocellular carcinoma: a propensity score analysis. HPB (Oxford),2021,23(4):512-519.
[6] Durot I, Wilson S R, Willmann J K. Contrast-enhanced ultrasound of malignant liver lesions. Abdom Radiol (NY),2018,43(4):819-847.
[7] Cao X, Liu Z, Zhou X, et al. Usefulness of real-time contrast-enhanced ultrasound guided coaxial needle biopsy for focal liver lesions. Abdom Radiol (NY),2019,44(1):310-317.
[8] Cong W M, Bu H, Chen J, et al. Practice guidelines for the pathological diagnosis of primary liver cancer: 2015 update. World J Gastroenterol,2016,22(42):9279-9287.
[9] 全亚宁,商晓杰,孟璇,等. 实时超声造影和融合影像导航下MWA与手术治疗PLC患者疗效比较. 实用肝脏病杂志,2020,23(4):581-584.
[10] Li Z, Wang C, Si G, et al. Image-guided microwave ablation of hepatocellular carcinoma (</=5.0 cm): Is MR guidance more effective than CT guidance? BMC Cancer,2021,21(1):366.
[11] Yu Q,Liu C, Navuluri R, et al. Percutaneous microwave ablation versus radiofrequency ablation of hepatocellular carcinoma: a meta-analysis of randomized controlled trials. Abdom Radiol (NY),2021,46(9):4467-4475.
[12] Tsochatzis A, Mazioti A, Iliadis G, et al.Percutaneous microwave ablation of liver lesions: differences on the sphericity index of the ablation zone between cirrhotic and healthy liver parenchyma. Diagnostics (Basel),2021,11(4):231.
[13] Shen ZZ, Lai K, Zhu RQ, et al. A feasibility study for determining ablative margin with 3D-CEUS-CT/MR image fusion after radiofrequency ablation of hepatocellular carcinoma. Ultraschall Med,2012,33(7):250-255.
[14] You Y, Zhang M, Li K, et al. Feasibility of 3D US/CEUS-US/CEUS fusion imaging-based ablation planning in liver tumors: a retrospective study. Abdom Radiol (NY),2021,46(6):2865-2874.
[15] Yu J, Yu X L, Cheng Z G, et al. Percutaneous microwave ablation of renal cell carcinoma: practice guidelines of the ultrasound committee of Chinese medical association, interventional oncology committee of Chinese research hospital association. Int J Hyperthermia,2020,37(1):827-835.
[16] Ding J, Wang D, Zhou Y, et al. A novel mono-modality fusion imaging method based on three-dimensional contrast-enhanced ultrasound for the evaluation of ablation margins after microwave ablation ofhepatocellular carcinoma. J Gastrointest Oncol,2021,12(1):184-195.
[17] Zhu Z X, Huang J W, Liao M H, et al. Treatment strategy for hepatocellular carcinoma in China: radiofrequency ablation versus liver resection. Jpn J Clin Oncol,2016,46(12):1075-1080.
[18] 龙颖琳,李凯,郑荣琴,等. 超声单模态融合成像技术在肝肿瘤热消融术中即时疗效评估中的初步应用. 中华超声影像学杂志,2017,26(4):306-310.
[19] Zrnc T A, Wallner J, Zemann W, et al. Assessment of tumor margins in head and neck cancer using a 3D-navigation system based on PET/CT image-fusion - a pilot study. J Craniomaxillofac Surg,2018,46(4):617-623.
[20] Pushparajah K, Chubb H, Razavi R. MR-guided cardiac interventions. Top Magn Reson Imaging,2018,27(3):115-128.

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

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