附属第三医院超声科//广东省肝脏疾病研究重点实验室,广东,广州,510630
网络首发:2017-09-16,
纸质出版:2017
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龙颖琳, 郑荣琴, 苏中振, 等. 超声融合成像在联合手术或操作的肝肿瘤消融术中疗效评估的应用[J]. 中山大学学报(医学科学版), 2017,38(5).
Application of Ultrasound Fusion Imaging in Treatment Response Assessment of Liver Tumors Ablation Combined with Surgeries or Procedures[J]. Journal of Sun Yat-sen University (Medical Sciences), 2017, 38(5).
【目的】比较超声(US)与计算机断层扫描(CT)或磁共振(MR)的融合成像(US-CT/MR融合成像)以及超声与三 维超声融合(US-US融合成像)在联合其他手术或操作的肝肿瘤消融术中疗效评估应用的价值。【方法】本研究纳入2015年 8月至2015年12月期间联合其他手术或操作(包括开腹手术、腹腔镜手术、人工胸腹水等)的肝肿瘤消融治疗患者,分别对 同一患者采用US-CT/MR融合成像和US-US融合成像结合超声造影进行术中即时消融疗效评估,比较两种融合成像技术适 用率、融合配准成功率及操作时间。术后观察并记录并发症发生情况,消融术后1~3月行增强CT/MR作为疗效评估金标 准。【结果】共50例患者合计67个病灶纳入本研究,其中包括消融联合人工胸腹水37例47个病灶,联合开腹手术10例14个 病灶,腹腔镜手术5例8个病灶。US-US融合成像技术适用率为52.5%(35/67),显著低于US-CT/MR融合成像技术适用率 [98.7%(66/67)](P < 0.001);而US-US融合成像的配准成功率为88.6%(31/35),显著高于US-CT/MR融合成像配准成功率 [66.7%(44/66)](P = 0.018)。US-US 融合成像操作时间[3.8 min(2.7 ~ 10.0 min)]显著短于 US-CT/MR 融合成像[5.5 min (3.0 ~ 14.0 min)](P < 0.001)。随访期内均未发现消融相关主要并发症,术后1 ~ 3个月内复查增强CT/MR,消融技术有效 率为100%(62/62)。【结论】对于术中联合其他手术或操作的肝肿瘤消融术,病灶超声显示清楚者优先选择US-US融合成 像,尤其是联合开腹手术的患者;而病灶超声显示不清时,部分患者也可选择US-CT/MR融合成像。
【Objective】To compare the clinical application value of fusion imaging of ultrasound(US)and computed tomogra? phy(CT)or magnetic resonance(MR)(US-CT/MR fusion imaging)and fusion imaging of US and three-dimensional US(US-US fusion imaging)in treatment response assessment of thermal ablation combined with other surgeries and procedures.【Methods】This clinical research included patients confirmed with liver cancers that underwent thermal ablation combined with other surgeries and procedures from Aug to Dec 2015. Both US-CT/MR and US-US fusion imaging together with contrast-enhanced US was applied on the same patient to assess the treatment response of the thermal ablation during the ablation procedure. The applicable rate,the success rate of registration and the duration required for fusion imaging were recorded and compared. Contrast-enhanced CT/MR 1-3 months after the ablation procedure was taken as the golden reference of the technical efficacy rate for ablation.【Results】67 liver can? cers in 50 patients were enrolled in this clinical research in total. The ablation of 47 lesions in 37 patients were combined with artifi? cial hydrothorax or ascites,14 lesions in 10 patients with open surgeries and 8 lesions in 5 patients with laparoscopy surgeries. Theapplicable rate for US-US fusion imaging[52.5%(35/67)]was lower than that for US-CT/MR fusion imaging[98.7%(66/67)](P < 0.001)while the success rate of registration for US-US fusion imaging[88.6%(31/35)]was higher than that for US-CT/MR[66.7% (44/66)](P = 0.018). The duration time for US-US fusion imaging[3.8 min(2.7 ~ 10.0 min)]was significantly shorter than that for US-CT/MR fusion imaging[5.5 min(3.0 ~ 14.0 min)](P < 0.001). No major complication related to ablation was observed. The technical efficacy rate for ablation was 100%(62/62)according to the contrast-enhanced CT/MR 1-3 months after the ablation proce? dure.【Conclusion】For ablation combined with other surgeries and procedures,US-US fusion imaging should be priority when the tumor is conspicuous in US,especially for cases combined with open surgeries while US-CT/MR fusion imaging should be selected in some cases when the tumor is inconspicuous on US.
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