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目的探讨超声造影实时动态观察特殊部位肝癌微波消融联合无水乙醇治疗的应用价值。方法对45例特殊部位肝癌患者,共73个病灶,分为两组对比观察:微波消融组(A组)和微波消融+无水乙醇联合治疗组(B组)。A组共32个,其中邻近大血管或胆管处6个,靠近膈肌或肝包膜处16个,邻近周围重要器官处10个;B组共41个,其中邻近大血管或胆管处9个,靠近膈肌或肝包膜处19个,邻近周围重要器官处13个;每组分别行超声造影检查,同期行增强MRI进行比较。结果 (1)超声造影检查发现A组完全消融22个,未完全消融10个,完全消融率为68%;B组完全消融37个,未完全消融4个,完全消融率为90%。(2)增强MRI检查发现A组完全消融20个,未完全消融12个,完全消融率为62%;B组完全消融35个,未完全消融6个,完全消融率为85%。(3)A组与B组分布部位差异无统计学意义(P>0.05),超声造影发现B组疗效优于A组,差异有统计学意义(P<0.05);超声造影与增强MRI间比较差异无统计学意义(P>0.05)。结论微波消融联合无水乙醇治疗特殊部位肝癌有较好的疗效,超声造影能实时动态观察肝癌血流灌注情况,对特殊部位肝癌治疗有重要的临床指导意义。
Objective To investigate the value of real-time dynamic contrast-enhanced ultrasound in the treatment of liver cancer with microwave ablation and absolute ethyl alcohol in patients with liver cancer. Methods Forty-five patients with hepatocellular carcinoma at a special site were divided into two groups: control group (group A) and microwave ablation + ethanol group (group B). A group of 32, of which 6 adjacent to the large blood vessels or bile duct, close to the diaphragm or liver capsule at 16, adjacent to the surrounding vital organs at 10; B group, a total of 41, of which adjacent to the large blood vessels or bile duct at 9, Adjacent to the diaphragm or hepatic capsule in 19, adjacent to the surrounding vital organs at 13; each group were examined by contrast-enhanced ultrasound compared with enhanced MRI. Results (1) Ultrasound angiography showed that group A completely ablated 22, incomplete ablation 10, complete ablation rate 68%; group B completely ablated 37, not completely ablated 4, the complete ablation rate was 90%. (2) MRI examination revealed complete ablation of 20 patients in group A, incomplete ablation of 12, complete ablation rate of 62%; group B completely ablated 35, not completely ablated 6, the complete ablation rate was 85%. (3) There was no significant difference in the distribution sites between group A and group B (P> 0.05). Contrast-enhanced ultrasonography showed that the effect of group B was better than group A (P <0.05) The difference was not statistically significant (P> 0.05). Conclusions Microwave ablation combined with absolute ethanol has a good curative effect in the treatment of liver cancer of special sites. The contrast-enhanced ultrasound can observe the blood perfusion of liver cancer in real time and has important clinical significance for the treatment of liver cancer of special sites.