|本期目录/Table of Contents|

 LI Ning,FAN Yun-xiang,ZHENG Cheng-huan.Application value of contrast-enhanced ultrasound in laparoscopic hepatectomy for T1 hepatocellular carcinoma[J].Journal of Tianjin Medical University,2023,29(01):68-72.





Application value of contrast-enhanced ultrasound in laparoscopic hepatectomy for T1 hepatocellular carcinoma
(天津医科大学第二医院健康体检科,天津 300211)
LI NingFAN Yun-xiangZHENG Cheng-huan
(Health Physical Examination Center,The Second Hospital ,Tianjin Medical University,Tianjin 300211,China )
contrast-enhanced ultrasound T1 hepatocellular carcinoma laparoscopic hepatectomy
目的:探讨超声造影(CEUS)技术在腹腔镜T1期肝细胞癌(HCC)切除术中的应用价值。方法:选择2018年1月—2020年12月于天津医科大学第二医院行腹腔镜T1期HCC切除术的患者80例,根据是否行术前CEUS将患者分为造影组和对照组(每组40例)。均在距肿瘤边缘0.5 cm处切开患者肝脏实质并完整切除肿瘤,然后在切缘3个不同位置取组织活检。采用免疫组化检测癌组织中增殖细胞核抗原(PCNA)及Bcl-2相关X蛋白(Bax)的表达水平。记录患者手术时间、术中出血量、住院时间、肿瘤直径、切缘长度、术后进食时间、拔除引流管时间、术后最高丙氨酸氨基转移酶(ALT)和总胆红素(TBIL)及其恢复正常时间。术后均行规律随访观察。结果:与对照组相比,造影组手术时间(t=11.69,P<0.001)及住院时间更短(t=9.40,P<0.001),术中出血量更少(t=14.86,P<0.001);而两组患者在肿瘤直径(t=0.28,P=0.78)、切缘长度(t=0.18,P=0.86)、术后进食时间(t=0.44,P=0.66)及拔除引流管时间(t=1.16,P=0.25)方面差异均无统计学意义。造影组手术后最高ALT(t=5.95,P<0.001)和TBIL(t=3.78,P<0.001)均低于对照组,ALT(t=2.38,P=0.02)及TBIL(t=2.03,P=0.046)恢复正常时间也较对照组更短。造影组切缘活检未见阳性肿瘤细胞;对照组6例患者切缘活检共11处发现阳性肿瘤细胞,肿瘤阳性标本总体检测率为9.17%(P=0.002)、肿瘤阳性患者总体检测率为15%(P=0.03)。造影组PCNA阳性表达率为7.5%,Bax阳性率为50%;对照组分别为17.5%、39.2%(χ2=5.49、2.85,均P<0.05)。术后1年,造影组无复发;对照组复发7例。结论:CEUS技术引导的腹腔镜T1期HCC切除术可以在手术切除边距相同的条件下精准切除癌灶,减轻肝脏损伤,减少出血,加速肝功能恢复,降低肿瘤复发率,同时缩短手术及住院时间。
Objective: To explore the application value of contrast-enhanced ultrasound(CEUS) in laparoscopic hepatectomy for T1 hepatocellular carcinoma(HCC) systematically. Methods:A total of 80 patients with T1 HCC who underwent laparoscopic hepatectomy from January 2018 to December 2020 in the Second Hospital of Tianjin Medical University were randomly divided into contrast group and control group(40 cases per group) according to whether the patients underwent CEUS. In both groups,the liver parenchyma was cut 0.5 cm away from the edge of the tumor with complete tumor resection. Then the tissues were taken at three different positions of the cutting edge for biopsy. The expression levels of proliferating cell nuclear antigen(PCNA) and Bcl-2 associated X protein(Bax) in cancer tissues were detected by immunohistochemistry staining. The operation time,intraoperative blood loss,hospitalization time,tumor diameter,cutting edge length,postoperative feeding time,drainage tube removal time,the hightest alanine aminotransferase(ALT) and total bilirubin (TBIL) and their recovery time were recorded. The patients in both groups were followed up regularly. Results:Compared with the control group,the operation time (t=11.69,P<0.001) and hospitalization time(t=9.40,P<0.001) of the contrast group were shorter,and the intraoperative blood loss was less(t=14.86,P<0.001),and the difference was statistically significant. However,there was no significant statistical difference in tumor diameter (t=0.28,P=0.78),cutting edge length (t=0.18,P=0.86),postoperative feeding time (t=0.44,P=0.66) and drainage tube removal time (t=1.16,P=0.25) between the two groups. The highest ALT (t=5.95,P<0.001) and TBIL (t=3.78,P<0.001) in the contrast group were lower than those in the control group after operation; while,the time of ALT (t=2.38,P=0.02) and TBIL (t=2.03,P=0.046) returned to normal was shorter than that in the control group,the difference was statistically significant. No positive tumor cells were found in the incision margin biopsy of the contrast group; while positive tumor cells were found in 11 biopsy sites of 6 patients in the control group. The overall detection rate of tumor-positive specimens was 9.17%(P=0.002),and that of tumor-positive patients was 15% (P=0.03). In the contrast group,the positive expression rate of PCNA was 7.5% and the positive rate of Bax was 50%; while that in the control group was 17.5% and 39.2% separately(χ2=5.49,2.85,both P<0.05). One year after surgery,there was no recurrence in the contrast group,while recurrence occurred in 7 patients in the control group. Conclusion:The laparoscopic hepatectomy of T1 HCC guided by CEUS can completely remove the tumor as much as possible under the same surgical margin,shorten the operation and hospitalization time,reduce bleeding,reduce liver damage,accelerate liver function recovery,and reduce tumor recurrence rate.


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更新日期/Last Update: 2023-02-01