| 骆永利,胡巧洪,何晓东.热消融治疗血管旁肝癌残留的影响因素分析[J].肿瘤学杂志,2021,27(5):383-389. |
| 热消融治疗血管旁肝癌残留的影响因素分析 |
| Influencing Factors for Tumor Residue of Perivascular Hepatocellular Carcinoma Following Ultrasound-guided Thermal Ablation |
| 投稿时间：2021-02-02 |
| DOI：10.11735/j.issn.1671-170X.2021.05.B011 |
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| 中文关键词: 肝癌 热消融术 血管 残留肿瘤 |
| 英文关键词:liver cancer thermal ablation vessel residual tumor |
| 基金项目:浙江省卫生健康委员会科研基金项目(2017KY206) |
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| 中文摘要: |
| 摘 要：［目的］ 探讨超声引导下热消融治疗血管旁肝癌后残留的影响因素。［方法］ 回顾性分析2017年1月至2020年5月行超声引导下热消融治疗肝癌患者198例，共274枚肿瘤，其中位于血管旁肝癌73枚(以下称血管旁组)，非血管旁肝癌201枚(以下称非血管旁组)。用热消融术后1~3个月内的增强MRI判定病灶是否残留。比较两组病灶的残留率；同时分析性别、年龄、肝硬化史、肝功能分级、肝脏手术史、原发性与转移性肿瘤、肿瘤最大径、消融方式、消融时间、瘤旁血管类型、直径、术中超声造影显示残留后补充消融对血管旁肝癌残留率的影响。［结果］ 274枚肿瘤中，27枚残留，残留率为9.9%，其中血管旁组残留率为16.4%(12/73)，非血管旁组残留率为7.5%(15/201)，两组间比较差异有统计学意义(χ2=4.857，P=0.028)。血管旁组中，最大径≤3cm的肿瘤残留率为9.6%，＞3cm的肿瘤残留率为33.3%；肝静脉旁肝癌残留率为7.9%，门静脉旁肝癌残留率为25.7%；瘤旁血管直径≤5mm时残留率为8.7%，＞5mm时残留率为29.6%；术中超声造影显示残留后补充消融时残留率为9.3%，术中未行超声造影时残留率为36.8%。多因素分析显示，肿瘤最大径＞3cm(OR=5.930，95%CI：1.321~26.626)或肿瘤位于门静脉旁(OR=5.678，95%CI：1.108~29.095)术后残留风险增加；术中超声造影显示残留后补充消融(OR=0.155，95%CI：0.035~0.682)，术后残留风险降低。［结论］ 热消融治疗血管旁肝癌较非血管旁肝癌更易残留。肿瘤最大径＞3cm或位于门静脉旁的血管旁肝癌是残留的高风险因素；术中超声造影显示残留后补充消融是减少残留的有效措施。 |
| 英文摘要: |
| Abstract：［Objective］ To investigate influencing factors for tumor residue of perivascular hepatocellular carcinoma following ultrasound-guided thermal ablation. ［Methods］ Clinical and imaging data of 198 patients with hepatocellular carcinoma who underwent ultrasound-guided thermal ablation from January 2017 to May 2020，were retrospective analyzed. There were a total of 274 tumors in 198 patients，including 73 perivascular tumors(perivascular group)，and 201 non-perivascular tumors(non-perivascular group). For some patients the intraoperative contrast-enhanced ultrasonography was performed and supplemental ablation was given for residual tumors. The residual tumors were detected by follow-up enhance MRI within 1~3 months after thermal ablation, and the residual rate of the two groups were compared. The relationship of tumor residue with the gender，age，history of cirrhosis，Child-Pugh class，history of liver operation，primary and metastatic tumors，tumor maximum diameter，ablation method，ablation time，type of blood vessel adjacent to tumor，the diameter of blood vessel adjacent to tumor，and intraoperative contrast-enhanced ultrasonography was analyzed. ［Results］ Among 274 tumors of 198 patients, 27 lesions remained after ablation with a residual rate of 9.9%. The residual rate of perivascular group was higher than that of non-perivascular group [16.4%(12/73) vs. 7.5%(15/201)，χ2=4.857，P=0.028]. In the perivascular group，the residual rate of the tumor with maximum diameter <3cm and >3cm were 9.6% and 33.3%；the residual rate of tumor adjacent to the hepatic vein and the portal vein were 7.9% and 25.7%；while for adjacent vessel diameter ≤5mm and ＞5mm，the residual rate were 8.7% or 29.6%，respectively. And the residual rate was 9.3% for patients having intraoperative contrast-enhanced ultrasonography，and that was 36.8% for those without intraoperative contrast-enhanced ultrasonography. Multivariate analysis showed that the maximum diameter of the tumor >3cm(OR=5.930，95%CI：1.321~26.626, P<0.05) and the tumor adjacent to portal vein(OR=5.678，95%CI：1.108~29.095, P<0.05) were risk factors of tumor residue; while the intraoperative contrast-enhanced ultrasonography for the following supplemental ablation was the protective factor(OR=0.155，95%CI：0.035~0.682, P<0.05). ［Conclusion］ During thermal ablation，perivascular liver cancer is more likely to remain than non-perivascular liver cancer. For the perivascular liver cancer the largest diameter＞3cm，and the tumor located next to the portal vein may increase the risk of tumor residue; while the intraoperative contrast-enhanced ultrasonography and the following supplement ablation is an effective measure to reduce the residual tumors. |
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