实时超声造影和融合影像导航下微波消融与手术治疗小肝癌患者疗效比较*

doi:10.3969/j.issn.1672-5069.2020.04.032

摘要/Abstract

摘要： 目的研究实时超声造影和融合影像导航技术下微波消融与手术治疗小肝癌患者的疗效。方法 2013年12月～2016年12月我院收治的142例原发性肝癌患者被随机分为两组,每组71例。对观察组患者实施实时超声造影和融合影像导航下微波消融治疗,给予对照组实施外科手术切除治疗。采用酶速率法测定血清α-L-岩藻糖苷酶(AFU)水平,采用ELISA法测定血清甲胎蛋白(AFP)水平,采用免疫放射法测定血清糖类抗原19-9(CA19-9)水平。结果在术后3个月,观察组肿瘤完全消融率为93.8%,对照组完全切除率达100.0%(P>0.05);两组血清AFP、AFU和CA19-9水平比较差异无统计学意义(P＞0.05);术后,观察组肺部感染、胆漏、皮肤切口感染、腹腔或胸腔积液等并发症发生率为4.2%,显著低于对照组的25.3%(P＜0.05);随访3～36个月(中位随访18个月),观察组累积生存率为73.2%(52/71),对照组为71.8%(51/71),两组差异无统计学意义(Log-rank值=0.086,P=0.763)。结论在实时超声造影联合融合影像导航技术支持下行微波消融治疗小肝癌患者,疗效与手术切除相当,但并发症更少,值得临床积极开展和验证。

关键词: 原发性肝癌, 小肝癌, 实时超声造影, 融合影像导航, 微波消融, 治疗

Abstract: Objective The aim of this study was to observe the efficacy of microwave ablation (MWA) under the guidance of real-time contrast-enhanced ultrasound(CEU) and fusion image navigation (FIN) in treatment of patients with small primary liver cancer (PLC).Methods 142 patients with small PLC were admitted to our hospital between December 2013 and December 2016, and were randomly divided into two groups, with 71 cases in each group. The patients in observation group received MWA under the real-time CEU and FIN guidance, and those in the control group received surgical resection. Serum alpha-fetoprotein (AFP),α-L-fucosidase (AFU) and carbohydrate antigen 19-9 (CA19-9)levels were assayed. Results At the end of three months after treatment, the complete ablation rate in the observation group was 93.8%, and the complete removal in the control was 100.0%(P>0.05); there were no significant differences as compared to serum AFP, AFU and CA19-9 levels in the two groups(P＞0.05); the complication occurrence, such as pulmonary infection, bile leak, incision infection,peritoneal or pleural effusion in the observation group was4.2%, significantly lower than 25.3%(P＜0.05) in the control; the patients were followed-up for 3 to 36 months withmedium of 18 months, and the survival rate in the observation was 73.2%(52/71), not significantly different compared to 71.8%(51/71) in the control (Log-rank=0.086,P=0.763).Conclusion The application of MWA under the guidance of real-time CEU and FIN in the treatment of patients with small PLC is efficacious, similar to surgical resection, which is worthy of clinicalverification.

Key words: Hepatoma, Small liver cancer, Real time contrast-enhanced ultrasound, Fusion image navigation, Microwave ablation, Surgery

全亚宁, 商晓杰, 孟璇, 高榆秀. 实时超声造影和融合影像导航下微波消融与手术治疗小肝癌患者疗效比较^*[J]. 实用肝脏病杂志, 2020, 23(4): 581-584.

Quan Yaning, Shang Xiaojie, Meng Xuan, et al. Application of microwave ablation in treatment of patients with small primary liver cancer under real-time contrast-enhanced ultrasound and fusion image navigation guidance[J]. Journal of Practical Hepatology, 2020, 23(4): 581-584.

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实时超声造影和融合影像导航下微波消融与手术治疗小肝癌患者疗效比较^*

Application of microwave ablation in treatment of patients with small primary liver cancer under real-time contrast-enhanced ultrasound and fusion image navigation guidance

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