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中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (04) : 323 -326. doi: 10.3877/cma.j.issn.2095-3232.2018.04.016

所属专题: 文献

临床研究

肝肿瘤热消融术中穿刺活检病理学诊断可行性分析
谭雷1, 傅斌生2, 吴泽倩3, 曾庆劲1, 许尔蛟1, 郑荣琴1, 李凯1,()   
  1. 1. 510630 广州,中山大学附属第三医院超声科
    2. 510630 广州,中山大学附属第三医院肝移植科
    3. 510630 广州,中山大学附属第三医院感染性疾病科
  • 收稿日期:2018-05-02 出版日期:2018-08-10
  • 通信作者: 李凯
  • 基金资助:
    国家重点研发计划(2017YFC0112000); 广州市科技计划项目(201704020164)

Analysis on feasibility of needle biopsy pathological diagnosis during liver tumor thermal ablation

Lei Tan1, Binsheng Fu2, Zeqian Wu3, Qingjin Zeng1, Erjiao Xu1, Rongqin Zheng1, Kai Li1,()   

  1. 1. Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    2. Department of Liver Transplantation, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
    3. Department of Infectious Disease, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2018-05-02 Published:2018-08-10
  • Corresponding author: Kai Li
  • About author:
    Corresponding author: Li Kai, Email:
引用本文:

谭雷, 傅斌生, 吴泽倩, 曾庆劲, 许尔蛟, 郑荣琴, 李凯. 肝肿瘤热消融术中穿刺活检病理学诊断可行性分析[J]. 中华肝脏外科手术学电子杂志, 2018, 07(04): 323-326.

Lei Tan, Binsheng Fu, Zeqian Wu, Qingjin Zeng, Erjiao Xu, Rongqin Zheng, Kai Li. Analysis on feasibility of needle biopsy pathological diagnosis during liver tumor thermal ablation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(04): 323-326.

目的

探讨超声引导下肝肿瘤热消融术中穿刺活检的可行性及临床价值。

方法

本前瞻性研究对象为2015年8月至2016年7月在中山大学附属第三医院行超声引导下肝肿瘤消融治疗的39例患者。患者均签署知情同意书,符合医学伦理学规定。其中男28例,女11例;平均年龄(53±12)岁。临床诊断为原发性肝癌31例,肝转移癌1例,肝良性病灶7例。病灶直径11~43 mm,中位直径23 mm。消融术中采用COOK半自动活检针对肿瘤进行超声引导下穿刺活检。观察患者术后并发症发生情况。

结果

39例患者均穿刺成功并获得明确病理学诊断。病理学检查诊断符合原发性肝癌31例,肝转移癌1例,肝血管瘤2例,局灶性增生结节2例,肝腺瘤1例,不典型增生结节2例,阳性率100%。术后未发现穿刺针道出血。

结论

超声引导下肝肿瘤热消融术中穿刺活检安全、可行,既可达到治疗目的又可明确诊断。

Objective

To explore the feasibility and clinical value of ultrasound-guided needle biopsy during liver tumor thermal ablation.

Methods

A total of 39 patients who underwent ultrasound-guided liver tumor ablation in the Third Affiliated Hospital of Sun Yat-sen University from August 2015 to July 2016 were enrolled in this prospective study. The informed consents of all patients were obtained and the local ethical committee approval was received. There were 28 males and 11 females, with an average age of (53±12) years. 31 cases were diagnosed with primary liver cancer (PLC), 1 case with hepatic metastases and 7 cases with benign hepatic lesions. The diameter of lesions were 11-43 mm, with a median of 23 mm. Ultrasound-guided needle biopsy of the tumors was performed with COOK semi-automatic biopsy needle during ablation. Postoperative complications were observed.

Results

The operations of all 39 patients were performed successfully and the disease was confirmed pathologically. 31 cases of PLC, 1 case of hepatic metastases, 2 cases of hepatic hemangioma, 2 cases of focal nodular nodules, 1 case of hepatic adenoma and 2 cases of atypical hyperplasia nodules were confirmed by pathological examination, and the positive rate was 100%. No puncture tract bleeding was observed.

Conclusions

Ultrasound-guided needle biopsy during liver tumor thermal ablation is safe and feasible, which can not only achieve the goal of treatment, but also make a definitive diagnosis.

[1]
Boskovic A, Kitic I, Prokic D, et al. Sample representativeness and incidence of liver biopsy complications caused by needles of bigger diameter (1.6 mm) and smaller diameter (1.2 mm) in children with cholestatic syndrome[J]. Med Pregyl, 2013(66):367-371.
[2]
Kose S, Ersan G, Tatar B, et al. Evaluation of percutaneous liver biopsy complications in patients with chronic viral hepatitis[J].Eurasian J Med, 2015(47):161-164.
[3]
Bhardwaj N, Strickland AD, Ahmad F, et al. Liver ablation techniques: a review[J]. Surg Endesc, 2010, 24(2):254-265.
[4]
Ng KK, Poon RT, Lam CM, et al. Efficacy and safety of radiofrequency ablation for perivascular hepatocellular carcinoma without hepatic inflow occlusion[J]. Br J Surg, 2006, 93(4):440-447.
[5]
Kotoh K, Morizono S, Kohjima M, et al. Evaluation of liver parenchymal pressure and portal endothelium damage during radio frequency ablation in an in vivo porcine model[J]. Liver Int, 2005, 25(6):1217-1223.
[6]
DeWitt J, LeBlanc J, McHenry L, et a1. Endoscopic ultrasound-guided fine needle aspiration cytology of solid liver lesions:a large single-center experience[J]. Am J Gastroenterol, 2003, 98(9):1976-1981.
[7]
王艳苓,张红红,王秀燕.超声引导下经皮肝脏穿刺活检的临床价值[J].实用肝脏病杂志,2009,12(1):52-54.
[8]
李凯,许尔蛟,郑荣琴,等.融合成像超声造影术中即时评估肝癌射频消融疗效[J].中华超声影像学杂志,2013,22(7):587-590.
[9]
徐建红,王知力,汪伟安,等.超声造影在肝占位性病变穿刺活检中的应用价值[J].中华超声医学杂志,2010,26(10):922-924.
[10]
Von Herbay A, Westendorff J, Gregor M. Contrast-enhanced ultrasound with SonoVue: differentiation between benign and malignant focal liver lesions in 317 patients[J]. J Clin Ultrasound, 2010, 38(1):1-9.
[11]
Cho YK, Kim Y, Rhim H. Pitfalls in the radiological and pathological correlation of tumour response rates of hepatocellular carcinoma following radiofrequency ablation[J]. J Clin Pathol, 2009, 62(12):1071-1073.
[12]
Choi D, Lim HK, Rhim H, et al. Percutaneous radiofrequency ablation for early-stage hepatocellular carcinoma as a first-line treatment: long-term results and prognostic factors in a large single-institution series[J]. Eur Radiol, 2007(17):684-692.
[13]
Morimoto M, Sugimori K, Shimto K,et al.Treatment of hepatocellular carcinoma with radiofrequency ablation: radiologic-histologic correlation during follow-up periods[J].Hepatology, 2002, 35(6):S146-147.
[14]
Ikemoto T, Shimada M, Yamada S. Pathophysiology of recurrent hepatocellular carcinoma after radiofrequency ablation[J]. Hepatol Res, 2017, 47(1):23-30.
[15]
Kalogeridi MA, Zygogianni A, Kyrgias G, et al. Role of radiotherapy in the management of hepatocelluelar carcinoma: a systematic review[J]. World J Hepatol, 2015, 7(1):101-112.
[16]
Yoshida S, Kornek M, Ikenaga N, et al. Sublethal heat treatment promotes epithelial-mesenchymal transition and enhances the malignant potential of hepatocellular carcinoma[J]. Hepatology, 2013(58):1667-1680.
[17]
Poggi G, Tosoratti N, Montagna B, et al. Microwave ablation of hepatocellular carcinoma[J]. World J Hepatol, 2015(7):2578-2589.
[18]
Nishikawa H, Osaki Y, Iguchi E, et al. Radiofrequency ablation for hepatocellular carcinoma: the relationship between a new grading system for the ablative margin and clinical outcomes[J]. J Gastroenterol, 2013, 48(8):951-965.
[19]
Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes[J]. Hepatology, 2016, 64(1):73-84.
[20]
Omata M, Cheng AL, Kokudo N, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update[J]. Hepatol Int, 2017, 11(4):317-370.
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