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目的比较肝移植术后与根治性切除术后复发性肝细胞癌(RHCC)的常规超声与超声造影(CEUS)表现,为不同方法治疗后RHCC的诊疗提供依据。方法对33例肝移植术后出现RHCC患者的超声资料(其中20例有CEUS资料)进行回顾性分析,并从同期接受根治性切除术后出现RHCC的152例患者中随机抽取33例(均接受常规超声和超声造影检查)进行比较。结果常规超声显示肝移植组RHCC发生部位与肝切除组差异有统计学意义(P=0.003),而复发灶的大小、数目、回声、边界、邻近重要结构、血供情况差异均无统计学意义(P均>0.05)。CEUS示RHCC增强水平、增强模式在肝移植组与肝切除组间差异均有统计学意义(P=0.017、0.048)。其中肝移植组高增强14例、等增强1例、低增强5例,肝切除组分别为32例、1例、0例;肝移植组“快进快退”13例、“快进慢退”1例、三期低增强5例、动脉期等增强门脉期低增强1例,肝切除组分别为30例、2例、0例、1例。增强形态在肝移植组(均匀增强19例,不均匀增强1例)与肝切除组间(均匀增强27例、不均匀增强6例)差异无统计学意义(P=0.339)。结论根治性切除术后RHCC大部分发生在肝内,而肝移植术后肝外复发病例较多。肝移植术后RHCC增强水平、增强模式多样,虽大多数有典型CEUS表现,但非典型表现占35.00%,应特别予以注意。
Objective To compare the performance of conventional ultrasound and contrast-enhanced ultrasound (CEUS) in the diagnosis of recurrent hepatocellular carcinoma (RHCC) after liver transplantation and radical resection, and to provide evidence for the diagnosis and treatment of RHCC after different methods of treatment. Methods The data of 33 patients with RHCC after liver transplantation were retrospectively analyzed by ultrasound data of 20 patients (with CEUS data) and 33 patients were randomly selected from 152 patients with RHCC after concurrent radical resection Conventional ultrasound and contrast echocardiography). Results Conventional ultrasonography showed that there was significant difference between the RHCC group and the liver resection group in the liver transplantation group (P = 0.003), while there was no significant difference in the size, number, echo, boundary, adjacent important structures and blood supply (P> 0.05). CEUS showed enhanced levels of RHCC, enhanced mode in liver transplantation group and liver resection group differences were statistically significant (P = 0.017, 0.048). The liver transplantation group had 14 cases of high enhancement, 1 case of equal enhancement and 5 cases of low enhancement. The liver resection group was 32 cases, 1 case and 0 case, respectively. The liver transplantation group had 13 cases of fast forward and fast reversion 1 case, 3 cases of low enhancement in 5 cases, arterial phase and other enhanced low portal hypertension enhanced in 1 case, liver resection group were 30 cases, 2 cases, 0 cases, 1 case. In the liver transplantation group, there was no significant difference (P = 0.339) between the liver transplantation group (uniform enhancement of 19 cases, uneven enhancement of 1 case) and the group of hepatectomy (uniform enhancement of 27 cases, uneven enhancement of 6 cases). Conclusion Most of the RHCC occurred in the liver after radical resection, but there were more cases of extrahepatic recurrence after liver transplantation. After liver transplantation, the level of enhancement of RHCC, enhanced mode of diversification, although most of the typical CEUS performance, but the typical performance of 35.00%, should pay special attention.