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目的:探讨超声造影(CEUS)在较大肝癌冷循环微波凝固治疗(PMCT)后残存病灶再次行PMCT治疗中的应用价值。方法:总结我院2008年6月至2013年8月165例肝癌患者经PMCT治疗后,残存病灶不同方式引导进行PMCT的病例资料。结果:本组病灶经CEUS后超声引导下行PMCT治疗后,残存病灶<3 cm及残存病灶≥3 cm的肝癌完全消融率分别达到100%(68/68)、81.63%(40/49),总消融率92.31%(108/117);复习增强CT/MRI后在灰阶超声引导下行PMCT治疗后残存病灶<3 cm及残存病灶≥3 cm的肝癌完全消融率分别达到100%(33/33)、60.87%(28/46),总消融率77.22%(61/79)。<3 cm残存病灶两组完全消融率均100%,差异无统计学意义;≥3 cm残存病灶两组完全消融率及两组总消融率差异有统计学意义(χ2=6.91,P=0.009;χ2=9.04,P=0.003)。所有病例消融术后无胆漏、感染、死亡等严重并发症发生。采用肝脏CEUS判断肿瘤残留,准确性为96.9%,与增强CT/MRI评估相当(P>0.05)。结论:肝脏CEUS能够精准指导肝癌残存病灶行PMCT,并可用于消融术后疗效评价和随访。
Objective: To investigate the value of CEUS in the treatment of residual lesions after microwave coagulation therapy (PMCT) of large hepatocellular carcinoma (HCC) re-treated with PMCT. Methods: From June 2008 to August 2013 in our hospital 165 cases of liver cancer patients after PMCT treatment, the residual lesions of different ways to guide the case of PMCT data. Results: The complete ablation rates of residual tumor> 3 cm and residual tumor> 3 cm in 100% (68/68) and 81.63% (40/49) of patients with CEUS after ultrasound guided PMCT were The complete ablation rates of residual tumor less than 3 cm and residual tumor more than 3 cm in 100% (33/33) patients after enhanced CT / MRI guided by grayscale ultrasound under the guidance of gray scale ultrasound were 92.31% (108/117) , 60.87% (28/46), the total ablation rate was 77.22% (61/79). The complete ablation rate of both groups with residual lesions less than 3 cm was 100%, and the difference was not statistically significant. The complete ablation rate and the total ablation rate of two groups with ≥ 3 cm residual lesions were statistically significant (χ2 = 6.91, P = 0.009; χ2 = 9.04, P = 0.003). No cases of bile leakage, infection, death and other serious complications occurred after ablation in all cases. Tumor remnant was detected by CEUS of liver, the accuracy was 96.9%, which was equivalent to enhanced CT / MRI assessment (P> 0.05). Conclusion: CEUS of liver can accurately guide PMCT of residual liver cancer and can be used in the evaluation of curative effect and follow-up after ablation.