【作者】 张丽；

【导师】 郭佳；

【作者基本信息】 第二军医大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 目的:探讨不同病理分型原发性肝癌的超声特性以及经皮肝穿刺瘤内注射无水酒精治疗效果的差异,增强普通超声在原发性肝癌的诊断和治疗中的应用价值。方法:(一)回顾性分析了2007年4月至10月期间在我院行手术治疗的552例原发性肝癌患者术前超声检查结果,统计肿瘤回声强弱、肿瘤位置、肿瘤边界是否清晰、肿瘤数目等超声特性,按照术后病理结果将其分为肝细胞型肝癌、胆管细胞型肝癌、混合型肝癌三组,采用SPSS统计软件分析各组之间超声特性的关系。(二)分别对34例肝细胞型肝癌、25例胆管细胞型肝癌术后复发患者行经皮肝穿刺瘤内注射无水酒精治疗并进行随访,观察其治疗效果,对比分析两组差异。结果:(一)按照病理结果分组对术前肿瘤超声特性统计结果进行卡方检验,得到如下结果:肿瘤回声强弱P=0.085,肿瘤位置P=0.024,肿瘤边界清与否P=0.001,肿瘤数目P=0.402,患者性别分布P=0.005。不同病理组之间肿瘤的位置、边界清晰度以及患者性别分布有统计学意义,肿瘤超声回声强度的分布和肿瘤数目无统计学意义。另外,根据肿瘤回声强弱进行分组并对其直径进行方差分析,可以得到P=0.000,即不同回声组的肿瘤直径之间有统计学差异。(二)对原发性肝癌术后复发患者行PEIT治疗并进行随访,观察其治疗效果,结果如下:肝细胞型肝癌组患者30例有效,有效率为88.24%(30/34),胆管细胞型肝癌组患者17例有效,有效率68%(17/25),进行卡方检验,p<0.05,即不同病理分型原发性肝癌术后复发患者行经皮肝穿刺瘤内注射无水酒精治疗疗效有统计学差异。结论:(一)不同病理分型的原发性肝癌有不同的超声特性,肝细胞型肝癌、混合型肝癌、胆管细胞型肝癌依次呈现出左叶发生率增高,边界清楚度降低,女性患者增多的特性。肿瘤超声回声强度和其直径大小成正相关,平均直径相同的肝细胞型肝癌回声强度要高于胆管细胞型肝癌。(二)经皮肝穿刺瘤内注射无水酒精治疗肝细胞型肝癌患者术后复发肿瘤效果明显好于胆管细胞型肝癌患者,胆管细胞癌患者术后复发可合并使用其他治疗方法以增强疗效。更多还原

【Abstract】 Objective To evaluate the ultrasounic characteristics and compare the therapeutic efficacy of percutaneous ethanol injection treatment(PEIT) of different histio-pathology types of primary liver cancer, wish to elevate the ability of applications of ordinary ultrasound examination in diagnosis and treatment of primary liver cancer. Methods (1) Retrospective analyze the preoperative ultrasound examination results including the echo intensity、tumor locality、definition of tumor edge、tumor numbers and distribution of gender of 552 cases of pimary liver cancer in Eastern Hepatobiliary Surgery Hospital from April to October in 2007 who have been operatived later,divide them to three groups as hepatocellular carcinoma(HCC)、Intrahepatic cholangiocarcinoma (ICC) and mixed hepatic carcinoma according to the histio-pathology types after operating and get the correlation ship of every group through SPSS statistic software.(2) choose and follow-up to visit 34 HCC patients and 25 ICC patients who were all postop and had recurrence tumor(diameter≤3cm and numbers≤3 ) those had been treated by PEIT. Compare and analyze the therapeutic efficacy. Results Statistic the ultrasound characteristics according to the histo-pathology results using chi-square test and get the results as follows:P(echo intensity)=0.085、P (tumor locality)=0.024、P(definition of tumor edge)=0.001、P(distribution of gender)=0.005、P ( tumor numbers ) =0.402。The tumor locality、definition of tumor edge、distribution of gender of different histo-pathology types have statistical signification. The echo intensity and tumor numbers haven’t statistic signification. But if divid the groups as the echo intensity and statistic the tumor diameters using ANOVA, we can get P=0.000, so the diameter of different echo intensity groups has statistical signification. (2) Analyze therapeutic efficacy of PEIT on the postop patients who have recurrence tumor (diameter≤3cm and numbers≤3), we can get the results as following: 30 cases were effective and the efficiency rate was 88.24% of HCC (30/34), 17 cases were effective and the efficiency rate was 68% of ICC (17/25). Through Chi-square test, there have signification of statistics ( p<0.05). Conclusion (1) Different histio-pathology types of primary liver cancer have different ultrasound characteristics. The incidence on the left lobe of liver and the incidence rates on women patients is increasing , the boundary definition is decreasing by turns of HCC、mixed hepatic carcinoma and ICC。The echo intensity is increasing with the diameter of tumor increasing. HCC′s echo intensity is higher than ICC′s when their diameter is same .(2) The therapeutic efficacy of PEIT on the recurence tumor of postop patient of HCC is superior to ICC. It is correlative with the pathological characteristics of HCC and ICC. So other treating measure should be taken on the recurrence tumor of ICC to elevate its therapeutic efficacy.更多还原