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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (04) : 315 -319. doi: 10.3877/cma.j.issn.1672-6448.2020.04.005

所属专题： 文献；

腹部超声影像学

三维可视化术前规划系统辅助超声引导微波消融联合肝动脉化疗栓塞治疗大肝癌效果的初步研究
袁迎春1, 袁晓春2, 王琦3, 高元瑾4, 刘方义4, 于晓玲4,†()   
  1. 1. 750004　宁夏医科大学总医院超声科
    2. 750004　宁夏医科大学总医院急诊科
    3. 750004　宁夏医科大学总医院肝胆外科
    4. 100853　北京，解放军总医院第一医学中心介入超声科
  • 收稿日期:2019-11-13 出版日期:2020-04-01
  • 通信作者: 于晓玲

Ultrasound-guided percutaneous microwave ablation assisted by three-dimensional planning system combined with transhepatic arterial chemoembolization for treating single large hepatocellular carcinoma: a primary study of survival

Yingchun Yuan1, Xiaochun Yuan2, Qi Wang3, Yuanjin Gao4, Fangyi Liu4, Xiaoling Yu4,†()   

  1. 1. Department of Ultrasound, General Hospital of Ningxia Medical University, Yinchuang 750004, China
    2. Department of Emergency Medicine, General Hospital of Ningxia Medical University, Yinchuang 750004, China
    3. Department of Hepatobiliary Surgery, General Hospital of Ningxia Medical University, Yinchuang 750004, China
    4. Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2019-11-13 Published:2020-04-01
  • Corresponding author: Xiaoling Yu
  • About author:
    Corresponding author: Yu Xiaoling, Email:
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袁迎春, 袁晓春, 王琦, 高元瑾, 刘方义, 于晓玲. 三维可视化术前规划系统辅助超声引导微波消融联合肝动脉化疗栓塞治疗大肝癌效果的初步研究[J]. 中华医学超声杂志（电子版）, 2020, 17(04): 315-319.

Yingchun Yuan, Xiaochun Yuan, Qi Wang, Yuanjin Gao, Fangyi Liu, Xiaoling Yu. Ultrasound-guided percutaneous microwave ablation assisted by three-dimensional planning system combined with transhepatic arterial chemoembolization for treating single large hepatocellular carcinoma: a primary study of survival[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(04): 315-319.

目的

评估三维可视化术前规划系统辅助超声引导下，经皮穿刺肝内病灶微波消融治疗直径大于5 cm的单病灶原发性肝细胞肝癌的安全性及临床应用价值。

方法

选取2015年5月至2017年8月在解放军总医院介入超声科接受微波消融治疗的40例患者，这些患者病灶均为单发大于5 cm原发性肝细胞肝癌，其中21例接受无三维术前规划的常规超声引导下经皮穿刺肝内病灶微波消融治疗，19例接受三维可视化术前规划辅助超声引导下肝内病灶微波消融治疗，采用Kaplan-Meier及Log-rank检验比较2组间有无复发生存及总生存的差异。

结果

三维术前规划组和无三维术前规划组1、3年总生存率分别为94.7%、38.5%，100.0%、34.4%，差异无统计学意义（P=0.745）；1、3年无进展生存率分别为100.0%、64.6%，89.5%、18.8%，差异有统计学意义（χ2=1.210，P=0.014）。两组患者均未出现消融相关严重并发症及死亡。

结论

三维可视化术前规划辅助超声引导下肝内病灶微波消融治疗大于5 cm原发性肝癌可提高消融治疗的无肿瘤进展生存率，并表现出较好的安全性，将为消融治疗提供新的辅助手段，为进一步智能消融治疗打下基础。

关键词: 成像，三维, 超声检查，介入性, 消融技术, 肝肿瘤
Objective

To evaluate the safety and clinical efficacy of three-dimensional (3D) visualization preoperative planning system assisted ultrasound-guided percutaneous microwave ablation for treating single large hepatocellular carcinoma (HCC).

Methods

Forty patients with a single large HCC (diameter ≥ 5 cm) from May 2015 to August 2017 were included, of whom 21 received ultrasound-guided percutaneous microwave ablation without 3D visualization assistance and 19 patients were treated under the assistance of 3D visualization. Survival and recurrence were recorded and compared between the two groups.

Results

The 1-year and 3-year overall survival rates of the 3D visualization group and no 3D visualization group were 94.7% and 38.5%, and 100% and 34.4%, respectively, which showed no statistical difference (P=0.745). The 1-year and 3-year recurrence free survival rates of the two groups were 100% and 64.6%, and 89.5% and 18.8%, respectively, which showed statistical differences (P=0.014). No severe complication or death occurred in either group.

Conclusion

3D visualization assisted ultrasound guided microwave ablation for primary liver cancer larger than 5 cm can improve the recurrence free survival rate and demonstrate good safety, thus providing a new auxiliary method for ablation and laying a foundation for intelligent ablation.

Key words: Imaging, three-dimensional, Ultrasonography, interventional, Ablation techniques, Liver neoplasms
图1 患者中年男性，体检发现右肝占位，超声造影检查图像。图a上：动脉期；下：延迟期，提示肝S7段占位，大小约54 mm×52 mm，结合病史诊断为原发性肝细胞肝癌。术前行三维术前规划，术后再次利用三维规划评估手术效果；图b上：术前磁共振及三维重建图像；下：术后磁共振及三维重建图像
表1 HCC患者三维规划组与无三维规划组一般资料比较
组别 例数 性别 年龄（岁，±s） 肿瘤最大径（cm，±s） Child-Pugh分级 消融前TACE治疗
男性 女性 A级 B级
三维规划组 19 94.7% 5.3% 59.4±9.86 6.1±1.13 73.7% 26.7% 73.7%
无三维规划组 20 95.0% 5.0% 61.4±8.15 6.0±0.78 87.5% 14.3% 81.0%
统计值   χ2=0.902 t=-0.706 t=0.249 χ2=0.902 χ2=0.302
P值   0.342 0.484 0.804 0.342 0.583
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