探讨多影像融合超声引导激光消融（LA）在特殊部位肝癌治疗中的临床应用价值。

本研究对象为2019年12月至2021年12月在云南省第一人民医院接受多影像融合超声引导LA治疗的28例特殊部位肝癌患者。患者均签署知情同意书，符合医学伦理学规定。其中男25例，女3例；年龄39~68岁，中位年龄55岁。病灶均为单发；直径0.5~1.9 cm；位于胆管或门静脉旁13例，胆囊旁8例，肝静脉旁7例。患者术前应用三维重建技术进行手术规划，术中在多影像融合超声导航系统引导下对病灶实施精准激光消融治疗。观察患者消融情况，术后随访6个月评估患者疗效与生存质量。

所有患者均完成多影像融合超声引导下的激光消融治疗，无发生围手术期并发症和死亡，恢复良好，顺利出院。25例术后AFP较术前降低，2例无明显改变，1例较前升高。术后6个月复查增强CT，28例患者中26例肿瘤完全消融，完全缓解率92.8%（26/28）；1例肿瘤直径较术前缩小60%以上，部分缓解率3.6%（1/28）；１例肿瘤直径无明显缩小，周围出现新发病灶，疾病进展率3.6%（1/28）。术后6个月患者生活质量评分：良好占75%（21/28），较好14%（4/28），一般11%（3/28）。

多影像融合超声引导LA能使复杂、高风险的特殊部位肝癌消融手术更精准、简便、安全，提高了手术精确性，降低了手术风险，实现精准治疗。

To evaluate the clinical value of multi-image fusion ultrasound-guided laser ablation (LA) in the treatment of liver cancer at special sites.

28 patients with liver cancer at special sites who received multi-image fusion ultrasound-guided LA in the First People's Hospital of Yunnan Province from December 2019 to December 2021 were enrolled. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 25 patients were male and3 female, aged from 39 to 68 years, with a median age of 55 years. All patients were diagnosed with a single lesion, 0.5-1.9 cm in diameter. The lesions were located adjacent to the bile duct or portal vein in 13 cases, adjacent to the gallbladder in 8 and adjacent to the hepatic vein in 7, respectively. Before surgery, three-dimensional reconstruction technology was adopted for surgical plan. Intraoperatively, multi-image fusion ultrasound-guided precision LA was performed. Clinical efficacy of LA was observed. Clinical efficacy and quality of life were evaluated during 6-month follow-up.

All patients completed multi-image fusion ultrasound-guided LA. No perioperative complications or death occurred. All patient recovered well and were discharged. Postoperative AFP level was decreased in 25 cases, not significantly changed in 2, and increased in 1. Enhanced CT scan at postoperative 6 months showed that 26 of 28 tumors were completely ablated, and the complete remission rate was 92.8%(26/28). After surgery, the diameter of one tumor was reduced by more than 60% compared with preoperative data, and the partial remission rate was 3.6%(1/28). The tumor diameter was not significantly decreased in 1 patient, new lesions were observed surrounding the lesion, and the disease-progression rate was 3.6%(1/28). The grade of life quality score at postoperative 6 months was good in 75%(21/28) of patients, moderate in 14%(4/28) and average in 11%(3/28).

Multi-image fusion ultrasound-guided LA can make the ablation of complex and high-risk liver cancer at special sites more accurate, simpler and safer, improve the precision of surgery, reduce the risk of surgery, thus to realize precise treatment.