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目的探讨超声造影对乙醇消融量化治疗肝细胞癌疗效判断以及在随访中的临床应用价值。方法经超声引导无水乙醇消融量化治疗肝癌54例,计54个肿瘤结节,分为A、B、C三组。A组于乙醇消融治疗结束时以及治疗后1个月复查,B组于治疗后12～14个月复查,C组于治疗24个月后复查。采用彩色多普勒超声及超声造影技术观察肿瘤结节大小、内部回声、血流及造影改变,并行超声引导穿刺活检。结果二维超声检查3组肝癌结节均较治疗前有不同程度缩小。A组肿瘤结节治疗结束时均为高回声,1个月后表现高回声或偏高回声者为52.4%(11/21),明显低于B、C两组表现为高回声或偏高回声的87.5%(14/16)、88.2%(15/17)(均P<0.05),而B、C两组间无明显差异(P>0.05)。彩色多普勒超声检查各组均未见血流信号。超声造影检查,A组结节在治疗结束时造影剂缺损区直径均超出原肿瘤,除A组3个肿瘤结节内见小片区域轻微增强外,余51个结节均未见增强。细针活检除A组3个结节内见残留肝癌细胞外,余均为纤维瘢痕组织及坏死组织。结论超声造影可较好评判肝癌乙醇消融量化治疗疗效,随访中能提供更多的诊断信息。
Objective To investigate the curative effect of contrast-enhanced ultrasound in the treatment of hepatocellular carcinoma by ethanol ablation and its clinical value in follow-up. Methods Fifty-four patients with hepatocellular carcinoma were treated by ultrasound-guided ablation of ethanol, accounting for 54 tumor nodules, divided into A, B and C groups. Group A at the end of the treatment of ethanol ablation and 1 month after treatment review, B group after 12-14 months of treatment review, C group after 24 months of treatment review. The size of tumor nodules, internal echo, blood flow and angiography were observed by color Doppler ultrasound and contrast-enhanced ultrasound, and biopsy was guided by ultrasound. Results Two-dimensional ultrasonography showed that the three groups of liver cancer nodules were reduced to varying degrees before treatment. A group of tumor nodules at the end of the treatment were hyperechoic, 1 month after the performance of hyperechoic or hyperechoic was 52.4% (11/21), significantly lower than B, C two groups showed hyperechoic or hyperechoic 87.5% (14/16) and 88.2% (15/17) respectively (all P <0.05), while there was no significant difference between B and C groups (P> 0.05). Color Doppler ultrasound examination showed no blood flow signal in each group. Contrast-enhanced ultrasound showed that the diameters of contrast-agent-deficient area in group A at the end of treatment were all beyond the original tumor, except that in the three tumor nodules in group A, slight enlargement was found in the small nodules, and no enhancement was found in more than 51 nodules. Needle biopsy except A group of 3 nodules, see residual liver cancer cells, more than the fiber scar tissue and necrotic tissue. Conclusion Contrast-enhanced ultrasound can be used to evaluate the efficacy of quantitative ethanol ablation for liver cancer, and provide more diagnostic information during follow-up.