【摘要】 目的探讨术中超声(IOUS)在肝癌切除术中的应用价值。方法术中超声引导下对269例肝癌患者行肝切除术或肝切除联合射频消融、无水乙醇注射治疗。并将术前常规超声、增强CT及术中超声检查结果与病理诊断结果进行对比分析。结果 (1)269例肝癌患者中因肿瘤累及肝内大血管行姑息性手术切除或放弃手术治疗17例;余252例(368个肝癌病灶,104个直径<1.5cm,264个直径≥1.5cm)术前常规超声显示肝癌病灶304个(82.6%)、增强CT显示肝癌病灶329个(89.4%)、术中超声显示肝癌病灶357个(97.0%,直径<1.5cm肝癌小病灶95个);术中超声对肝癌病灶的显示率高于术前常规超声及增强CT,差异有统计学意义(P<0.05);术中超声诊断直径<1.5cm肝脏恶性病灶的敏感度、特异度和准确度分别为88.1%、67.9%及82.1%。(2)术中超声引导下完成肝切除手术联合射频消融治疗15例(17个病灶);肝切除手术联合无水乙醇注射治疗2例(2个病灶),48例经术中超声检查改变了术前制定的手术方案。结论术中超声对肝癌病灶(尤其直径<1.5cm小病灶)显示率高,在肝癌切除术或射频、无水乙醇注射消融治疗中可引导临床医师精确操作,具有非常重要的临床价值。更多还原

【Abstract】 Objective To explore the clinical significance of intraoperative ultrasound(IOUS) in hepatectomy for liver cancer. Methods Two hundred sixty-nine patients with liver cancer had surgical exploration. IOUS was performed in these patients. The results of IOUS were compared with those of preoperative ultrasound and contrast enhanced CT according to the pathological results. Results Two hundred fifty-two of 269 patients took hepatectomy. Ninety-seven percent of nodules could be detected by IOUS, whereas preoperative ultrasound and contrast enhanced CT could detect 82.6% and 89.4% of nodules in 252 patients with 368 nodules, respectively. The difference of detection rates was statistically significant (P<0.05). The diameter of 104 nodules was smaller than 1.5 cm among all nodules, and IOUS could detect 95 nodules of 104 nodules. According to the pathological diagnostic results, the sensitivity, specificity and accuracy of IOUS were 88.1%, 67.9% and 82.1% for diagnosing malignant nodules(the diameter<1.5 cm), respectively. The operative plan was changed in terms of the IOUS results in 48 of 269 patients. Conclusions IOUS can refer reliable information for operation planning and precisely guide hepatectomy with significance.更多还原