目的 探讨术中超声对肝肿瘤切除患者的应用价值。方法 选择肝胆外科就诊的肝肿瘤患者,对患者做术前超声(preoperative ultrasonography, POUS)、CT及术中超声检查(intra-operative ultrasonography, IOUS),将患者的检查资料分为POUS组、CT组和IOUS组,再根据术后病理切片情况,比较以上三组检查对于不同直径范围的肝肿瘤的检出率,并对其做χ2检验,筛选出对于肝肿瘤检出特异性最高的检查。结果 IOUS对于肝肿瘤的检出率达98.7%,显著高POUS(80.2%)及术前CT检查(87.7%)。同时,IOUS检查对于微小病灶及小病灶的检出敏感率同样高于其余两者,差异均具有统计学意义(P<0.05)。结论 术中超声检查可以补充术前检查不足的信息,提高肿瘤检出率,减少肝肿瘤复发率,提高肝肿瘤切除患者的预后。
Objective To explore the value of intraoperative ultrasound for patients with hepatic tumor resection.Methods Patients with liver tumors were enrolled from the hepatic surgery department of our hospital.Preoperative ultrasonography (POUS), CT, and intraoperative ultrasonography (IOUS) were performed on the patients respectively.According to the postoperative pathological biopsy, the detection rates of liver tumors in different diameter ranges were compared among the three groups, and the χ2 test was performed to screen out the examination with the highest specificity for liver tumor.Results The detection rate of liver tumors by intraoperative ultrasound was 98.7%, significantly higher than the rates by preoperative ultrasound (80.2%) and preoperative CT examination (87.7%).At the same time, the sensitivity of intraoperative ultrasound examination for small lesions was higher than the other two, with significant differences (P<0.05).Conclusion Intraoperative ultrasonography can supplement preoperative information, improve the detection rate of tumors, reduce the recurrence rate of liver tumors, and improve the prognosis of patients with liver tumor resection.
[1] 伍兆锋,赖越元,朱光辉,等.腹腔镜精准肝切除治疗原发性肝癌的临床效果评价[J].泰山医学院学报, 2018,39(12):1412-1413.
[2] 刘兵,蒙轩,袁静,等.术中超声在肝脏恶性肿瘤切除手术中的临床应用研究[J].徐州医学院学报, 2016,36(2):107-110.
[3] 李晓航,张佳林,王学梅,等.术中超声在肝胰肿瘤手术中的应用[J].中国医科大学学报, 2009,38(5):355-356.
[4] 何淑宏.术中超声在肝脏肿瘤手术中的应用[J].河北医药, 2013,35(3):424-424.
[5] 中国抗癌协会肝癌专业委员会,中国抗癌协会临床肿瘤学协作专业委员会,中华医学会肝病学会肝癌学组,全国肝胆肿瘤及移植病理协作组.原发性肝癌规范化病理诊断方案专家共识[J].肿瘤, 2011,31(4):285-287.
[6] 张冰凌,孟锦,栗鸿宝.64层螺旋CT与超声检查对原发性肝癌和肝脏局灶性结节增生的诊断价值对比[J].河南医学研究, 2018,27(21):3881-3883.
[7] 雒夏,魏雅琪,海龙,等.肝癌血清标志物α-烯醇化酶在肝癌诊断中的初步研究[J].中华肝脏病杂志, 2019,27(7):505-510.
[8] 万赤丹,王国斌.原发性肝癌治疗进展[J].腹部外科, 2019,32(1):7-12.
[9] 高军喜,姚兰辉.术前经腹超声与术中超声诊断肝脏肿瘤的对比研究[J].临床超声医学杂志, 2008,10(2):95-98.
[10] Lin LW.aoperative ultrasonography in hepatobiliary surgery [J].HBPD INT, 2002,1(3):425-428.
[11] 董子秋.原发性肝癌超声造影参数与血管内皮生长因子、CD90表达的相关性研究[J].标记免疫分析与临床, 2018,25(10):1480-1521.
[12] 刘伟宗,贡雪灏,李征毅,等.术中超声造影在肝脏恶性肿瘤手术的应用价值[J].中国医学工程, 2015,23(5):89-90.
[13] 严翔,付必莽,唐波,等.射频消融术治疗原发性肝癌的临床研究进展[J].肝胆胰外科杂志, 2016,28(1):87-89.
[14] 朱昱,顾玲玲,杜学峰,等.术中超声对肝癌切除术中微小病灶的检出价值[J].中国乡村医药, 2019,26(2):22-23.
[15] 杨晓环,黄十佳,于杰,等.超声引导经皮微波消融治疗邻近血管的原发性肝癌的长期疗效[J].肿瘤学杂志, 2016,22(1):24-28.
[16] Gong NM, Yin HH, Cai WH, et al.IOUS and CE-IOUS during hepatic resection for patients with hepatocellular carcinoma in liver cirrhosis1[J].Clin Hemorheol Microcirc, 2019,71(4):483-498.
[17] Torzilli G, Procopio F, Cimino M, et al.Anatomical segmental and subsegmental resection of the liver for hepatocellular carcinoma: a new approach by means of ultrasound-guided vessel compression [J].Ann Surg, 2010,251(2),229-235.
[18] Garancini M, Gianotti L, Romano F, et al.The role of ultrasound in hepatic surgery[J].Hepatic Surg, 2013,1(1):207-222.
