Long Yinglin, Xu Erjiao, Zeng Qingjing, Ju Jinxiu, Huang Qiannan, Liang Ping, Zheng Rongqin, Li Kai
Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University Guangzhou, China.
Department of Medical Ultrasonic, The Eighth Affiliated Hospital of Sun Yat-sen University China.
Am J Cancer Res. 2020 Jul 1;10(7):2174-2184. eCollection 2020.
In certain difficult cases involving tumors unclear in B-mode ultrasound or tumors in a high-risk location, image-guided liver tumor thermal ablation was previously contraindicated. The aim of this retrospective study was to investigate the value of intra-procedural ultrasound fusion imaging in improving the therapeutic effect and safety of liver tumor ablation in difficult cases. A total of 502 patients (441 males and 61 females, aged 52 ± 11 years) with 805 liver tumors (16 ± 6 mm; range, 4-29 mm) who underwent thermal ablation with intra-procedural fusion imaging from October 2010 to June 2018 in our hospital were enrolled. Fusion imaging was employed for targeting, puncture guidance and immediate evaluation of the therapeutic response. Contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI) was performed one month after ablation and every 3~6 months in the follow-up period. 511 and 294 liver tumors were in classified in the difficult case group and the non-difficult case group, respectively. The technical efficacy rate was 99.4% (800/805), and no difference was found between the two groups (P=0.658). No significant difference in the local tumor progression rate was found between the difficult case group (1 year: 3.2%; 3 years: 7.6%; 5 years: 7.6%) and non-difficult case group (1 year: 2.1%; 3 years: 5.5%; 5 years: 11.6%) (P=0.874). The major complication rate was 1.8% (11/608). Injury to adjacent organs occurred in only 1 patient who sustained a bile duct injury. We conclude that intra-procedural fusion imaging can improve the therapeutic efficacy and safety of thermal ablation in difficult cases and may expand the indications for thermal ablation.
在某些B超检查中肿瘤情况不明确或肿瘤位于高风险位置的困难病例中，以往图像引导下的肝脏肿瘤热消融术被视为禁忌。本回顾性研究的目的是探讨术中超声融合成像在提高困难病例肝脏肿瘤消融治疗效果及安全性方面的价值。选取2010年10月至2018年6月在我院接受术中融合成像热消融治疗的502例患者（男441例，女61例，年龄52±11岁），共805个肝脏肿瘤（直径16±6mm；范围4 - 29mm）。融合成像用于靶点定位、穿刺引导及治疗效果的即时评估。消融术后1个月及随访期每3 - 6个月进行对比增强计算机断层扫描（CT）/磁共振成像（MRI）检查。分别将511个和294个肝脏肿瘤归入困难病例组和非困难病例组。技术有效率为99.4%（800/805），两组间无差异（P = 0.658）。困难病例组（1年：3.2%；3年：7.6%；5年：7.6%）与非困难病例组（1年：2.1%；3年：5.5%；5年：11.6%）的局部肿瘤进展率无显著差异（P = 0.874）。主要并发症发生率为1.8%（11/608）。仅1例患者出现邻近器官损伤，为胆管损伤。我们得出结论，术中融合成像可提高困难病例热消融的治疗效果及安全性，并可能扩大热消融的适应证。
