切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (06) : 499 -502. doi: 10.3877/cma.j.issn.2095-3232.2018.06.016

所属专题: 文献

临床研究

术前床旁超声在原发性肝癌手术中的应用
蒋小峰1,(), 张大伟1, 卢海武1, 温子龙1, 郑强1, 刘颂航1, 杨学伟1, 曹良启1, 彭和平1, 薛平1   
  1. 1. 510260 广州医科大学附属第二医院肝胆外科
  • 收稿日期:2018-08-30 出版日期:2018-12-10
  • 通信作者: 蒋小峰
  • 基金资助:
    广东省科技计划项目(2014A020212511)

Application of preoperative bedside ultrasound in surgical operation of primary liver cancer

Xiaofeng Jiang1,(), Dawei Zhang1, Haiwu Lu1, Zilong Wen1, Qiang Zheng1, Songhang Liu1, Xuewei Yang1, Liangqi Cao1, Heping Peng1, Ping Xue1   

  1. 1. Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, China
  • Received:2018-08-30 Published:2018-12-10
  • Corresponding author: Xiaofeng Jiang
  • About author:
    Corresponding author: Jiang Xiaofeng, Email:
引用本文:

蒋小峰, 张大伟, 卢海武, 温子龙, 郑强, 刘颂航, 杨学伟, 曹良启, 彭和平, 薛平. 术前床旁超声在原发性肝癌手术中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2018, 07(06): 499-502.

Xiaofeng Jiang, Dawei Zhang, Haiwu Lu, Zilong Wen, Qiang Zheng, Songhang Liu, Xuewei Yang, Liangqi Cao, Heping Peng, Ping Xue. Application of preoperative bedside ultrasound in surgical operation of primary liver cancer[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(06): 499-502.

目的

探讨术前床旁超声在原发性肝癌(肝癌)手术中的应用价值。

方法

回顾性分析2016年10月至2017年5月广州医科大学附属第二医院23例肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男15例,女8例;年龄27~73岁,中位年龄53岁。术前对患者行床旁超声检查,从剑突下、右肋缘下、肋间对肝脏进行扫描和彩色多普勒超声检查,与术前影像学资料进行对比。

结果

所有患者均在术前24 h内完成床旁超声检查。剑突下扫查可清楚显示第二肝门肝左、肝中和肝右静脉结构,并可进一步显示左半肝病灶所在肝段。右肋缘下扫描可显示第一肝门部解剖关系,显示门静脉解剖。肋间扫描可显示右半肝病灶位置,确定肝中、肝右静脉及右侧门静脉的肝内分布和病灶关系。病灶分布情况:肝Ⅱ、Ⅲ段6例,Ⅳ段5例,Ⅴ段2例,Ⅴ、Ⅷ段3例,Ⅵ段7例。术前床旁超声检查与术前CT、MRI检查不一致并停止手术1例,更改手术方案1例。

结论

术前床旁超声检查能为肝脏手术提供了更多解剖信息和病灶分布情况,可节约手术中探查的时间,并能及时调整手术方案。

Objective

To explore the application value of preoperative bedside ultrasound in the surgical operation of primary liver cancer (PLC).

Methods

Clinical data of 23 patients with PLC in the Second Affiliated Hospital of Guangzhou Medical University from October 2016 to May 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among 23 patients, 15 cases were male and 8 female, aged from 27 to 73 years with a median age of 53 years. Bedside ultrasound examination was performed in the patients. The liver was scanned and examined by Doppler ultrasound via the xiphoid process, the right costal margin and the intercostal space, and the results were compared with the preoperative imaging data.

Results

All the patients received bedside ultrasound examination within preoprative 24 h. The left, middle and right hepatic venous structures of the second porta could be displayed clearly by the scaning from xiphoid process, and the left hepatic segment where the lesions located could be further displayed. The scan form right costal margin showed the anatomical relationship of primary porta and the anatomy of portal vein. The scan from intercostal space could identify the position of lesions in the right lobe and determine the intrahepatic distribution of middle and right hepatic veins and right portal vein, and their relationship with lesions. The lesions located in segment Ⅱ and Ⅲ of 6 cases, segment Ⅳ of 5 cases, segment Ⅴ of 2 cases, segment Ⅴ and Ⅷ of 3 cases and segment Ⅵ of 7 cases. The findings of preoperative bedside ultrasound was inconsistent with that of preoperative CT and MRI. The operation was aborted in 1 case and operative plan was changed in 1 case.

Conclusions

Preoperative bedside ultrasound can provide more anatomical information and lesion distribution for liver surgery, which can shorten the intraoperative exploration time and adjust the surgical plan timely.

图1 两例肝肿瘤患者术前超声检查
[1]
床旁超声在急危重症临床应用专家共识组. 床旁超声在急危重症临床应用的专家共识[J]. 中华急诊医学杂志, 2016, 25(1):10-21.
[2]
Smit JM, Raadsen R, Blans MJ, et al. Bedside ultrasound to detect central venous catheter misplacement and associated iatrogenic complications: a systematic review and meta-analysis[J]. Crit Care, 2018, 22(1):65-80.
[3]
Torzilli G, Procopio F. State of the art of intraoperative ultrasound in liver surgery: current use for resection-guidance[J]. Chirurgia, 2017, 112(3):320-325.
[4]
Donadon M, Costa G, Torzilli G. State of the art of intraoperative ultrasound in liver surgery: current use for staging and resection guidance[J]. Ultraschall Med, 2014, 35(6):500-511.
[5]
Rethy A, Langø T, Mårvik R. Laparoscopic ultrasound for hepatocellular carcinoma and colorectal liver metastasis: an overview[J]. Surg Laparosc Endosc Percutan Tech, 2013, 23(2):135-144.
[6]
Morita Y, Takanishi K, Matsumoto J. A new simple navigation for anatomic liver resection under intraoperative real-time ultrasound guidance[J]. Hepatogastroenterology, 2014, 61(134):1734-1738.
[7]
Garancini M, Gianotti L, Delitala A, et al. Intraoperative ultrasound: a review on its role in liver surgery for primitive and metastatic tumors[J]. Minerva Chir, 2016, 71(3):201-213.
[8]
Takamoto T, Mise Y, Satou S, et al. Feasibility of intraoperative navigation for liver resection using real-time virtual sonography with novel automatic registration system[J]. World J Surg, 2018, 42(3):841-848.
[9]
Wang Z, Liu G, Lu MD, et al. Role of portal vein tumor thrombosis in quantitative perfusion analysis of contrast-enhanced ultrasound of hepatocellular carcinoma[J]. Ultrasound Med Biol, 2015, 41(5):1277-1286.
[10]
Margini C, Berzigotti A. Portal vein thrombosis: the role of imaging in the clinical setting[J]. Dig Liver Dis, 2017, 49(2):113-120.
[11]
Dănilă M, Sporea I, Popescu A, et al. The value of contrast enhanced ultrasound in the evaluation of the nature of portal vein thrombosis[J]. Med Ultrason, 2011, 13(2):102-107.
[12]
Bhatia V, Hijioka S, Hara K, et al. Endoscopic ultrasound description of liver segmentation and anatomy[J]. Dig Endosc, 2014, 26(3):482-490.
[13]
Shevchenko N, Schwaiger J, Markert M, et al. Evaluation of a resectable ultrasound liver phantom for testing of surgical navigation systems[J]. Conf Proc IEEE Eng Med Biol Soc, 2011:916-919.
[14]
Sun B, Lv Y, Xing D, et al. Imaging performance and clinical value of contrast-enhanced ultrasonography and computed tomography in the diagnosis of liver cancer[J]. Oncol Lett, 2018, 15(5):7669-7674.
[15]
Sanghvi T, Boyum J, Spilseth B, et al. MRI for hepatocellular carcinoma: a primer for magnetic resonance imaging interpretation[J]. Abdom Radiol, 2018, 43(5): 1143-1151.
[16]
Lee YJ, Lee JM, Lee JS, et al. Hepatocellular carcinoma: diagnostic performance of multidetector CT and MR imaging-a systematic review and meta-analysis[J]. Radiology, 2015, 275(1):97-109.
[17]
Lardière-Deguelte S, Ragot E, Amroun K, et al. Hepatic abscess: diagnosis and management[J]. J Visc Surg, 2015, 152(4):231-243.
[18]
Balci NC, Sirvanci M. MR imaging of infective liver lesions[J]. Magn Reson Imaging Clin N Am, 2002, 10(1):121-135.
[19]
Agrawal S, Agarwal S, Arnason T, et al. Management of hepatocellular adenoma: recent advances[J]. Clin Gastroenterol Hepatol, 2015, 13(7):1221-1230.
[20]
Vijay A, Elaffandi A, Khalaf H. Hepatocellular adenoma:an update[J]. World J Hepatol, 2015, 7(25): 2603-2609.
[1] 章建全, 程杰, 陈红琼, 闫磊. 采用ACR-TIRADS评估甲状腺消融区的调查研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 966-971.
[2] 罗辉, 方晔. 品管圈在提高甲状腺结节细针穿刺检出率中的应用[J/OL]. 中华医学超声杂志(电子版), 2024, 21(10): 972-977.
[3] 杨忠, 时敬业, 邓学东, 姜纬, 殷林亮, 潘琦, 梁泓, 马建芳, 王珍奇, 张俊, 董姗姗. 产前超声在胎儿22q11.2 微缺失综合征中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 852-858.
[4] 孙佳丽, 金琳, 沈崔琴, 陈晴晴, 林艳萍, 李朝军, 徐栋. 机器人辅助超声引导下经皮穿刺的体外实验研究[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 884-889.
[5] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[6] 高俊颖, 张海洲, 区泓乐, 孙强. FOLFOX-HAIC 为基础的肝细胞癌辅助转化治疗的应用进展[J/OL]. 中华普通外科学文献(电子版), 2024, 18(06): 457-463.
[7] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[8] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[9] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[10] 杭轶, 杨小勇, 李文美, 薛磊. 可控性低中心静脉压技术在肝切除术中应用的最适中心静脉压[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 813-817.
[11] 李一帆, 朱帝文, 任伟新, 鲍应军, 顾俊鹏, 张海潇, 曹耿飞, 阿斯哈尔·哈斯木, 纪卫政. 血GP73水平在原发性肝癌TACE疗效评价中的作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 825-830.
[12] 陆镜明, 韩大为, 任耀星, 黄天笑, 向俊西, 张谞丰, 吕毅, 王傅民. 基于术前影像组学的肝内胆管细胞癌淋巴结转移预测的系统性分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 852-858.
[13] 焦振东, 惠鹏, 金上博. 三维可视化结合ICG显像技术在腹腔镜肝切除术治疗复发性肝癌中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 859-864.
[14] 吴警, 吐尔洪江·吐逊, 温浩. 肝切除术前肝功能评估新进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 889-893.
[15] 吴雪云, 胡小军, 范应方. 肝切除术中剩余肝再生能力的评估与预测[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 894-897.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?