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目的探讨射频消融(RFA)治疗前超声造影(CEUS)对制定消融范围及治疗策略的应用价值,并与RFA前未应用CEUS的治疗组比较疗效。方法161例原发性肝癌符合经皮RFA入选条件患者进行超声引导RFA治疗。其中,77例RFA前采用SonoVue行CEUS检查(CEUS组),84例RFA前未行CEUS检查(非CEUS组)。两组病例的临床资料无明显差异。肿瘤平均直径CEUS组(3.6±1.2)cm,非CEUS组(3.5±1.1)cm。治疗后采用常规超声、增强CT及(或)超声造影等影像检查进行规律性随访,至少随访6个月CT判断肿瘤灭活程度。结果CEUS组77例105灶行RFA治疗,造影动脉期显示59灶(56.2%)肿瘤范围较造影前增大,其中42灶(71.2%)造影前肿瘤边界不清;49灶(46.7%)肿瘤形态较常规超声更不规则,其中39灶(79.6%)为造影前边界不清。造影组>3.5 cm肿瘤52灶,37灶(71.1%)在动脉期显示主荷瘤血管。10例CEUS新发现≤2.0 cm病灶16个,其中3例为肝硬化随访病例,均进行RFA治疗。两组平均治疗次数为1.2次和1.5次。RFA后随访6~36个月,CEUS组完全灭活率高于非CEUS组(95.4%对87.8%,P=0.042)。CEUS组生存期高于非CEUS组[(34.2±1.2)月对(30.2±1.6)月,P=0.028]。结论RFA前CEUS可清晰显示肿瘤浸润范围,灵敏发现卫星灶及其他区域微小病灶,确认荷瘤血管,为准确制定消融方案,施行治疗策略,整体覆盖灭活肿瘤提供了可靠的依据,从而有效地提高RFA对肝癌的治疗水平。
Objective To investigate the value of CEUS before radiofrequency ablation (RFA) in the treatment of ablation and the treatment strategy, and to compare the efficacy with the group without CEUS before RFA. Methods 161 patients with primary liver cancer who met the criteria of percutaneous RFA were treated with RFA. Among them, 77 patients with CEA before SonoVue (CEUS) and 84 patients without CEA before CEA (non-CEUS). The clinical data of two groups showed no significant difference. The mean tumor diameter was (3.6 ± 1.2) cm in the CEUS group and (3.5 ± 1.1) cm in the non-CEUS group. After treatment, regular ultrasound, enhanced CT and / or ultrasound contrast imaging and other regular follow-up, at least 6 months follow-up CT to determine the extent of tumor inactivation. Results In the CEUS group, 77 cases with 105 lesions underwent RFA. The tumor range of 59 lesions (56.2%) in the arterial phase of the CEUS group was larger than that before the contrast. Among 42 lesions (71.2%), the tumor boundary was unclear. Morphology is more irregular than conventional ultrasound, of which 39 (79.6%) were unclear before the contrast. Angiography group> 3.5 cm tumor 52 lesions, 37 lesions (71.1%) in the arterial phase showed the main tumor vessels. Ten cases of CEUS newly detected ≤2.0 cm lesions of 16, of which 3 cases were followed up for cirrhosis, were treated with RFA. The average number of treatments for both groups was 1.2 and 1.5 times. After RFA followed up for 6 to 36 months, the complete inactivation rate of CEUS group was higher than that of non-CEUS group (95.4% vs 87.8%, P = 0.042). The survival of the CEUS group was higher than that of the non-CEUS group [(34.2 ± 1.2) vs. (30.2 ± 1.6) months, P = 0.028]. Conclusion The CEUS of RFA can clearly show the extent of tumor infiltration, detect the satellite lesion and other small lesions sensitively, and confirm the tumor-bearing blood vessels. It provides a reliable basis for accurately setting the ablation program, implementing the treatment strategy and covering the inactivated tumor as a whole, thus effectively Improve the therapeutic level of RFA on liver cancer.