探讨实时虚拟导航系统在超声无法明确显示病灶的肝细胞肝癌（肝癌）患者射频消融（RFA）治疗中的临床价值。

对2010年11月至2012年3月中山大学附属第三医院收治的54例肝癌患者进行前瞻性研究。所有患者均签署知情同意书，符合医学伦理学规定。54例患者的62个经计算机断层摄影术（CT）或磁共振成像（MRI）检查提示有肝癌病灶但超声无法明确显示的肝癌病灶，在实时虚拟导航系统引导下行RFA治疗。观察RFA治疗中超声和CT或MRI图像融合情况及图像对位时间，计算图像融合成功率；观察术中及术后患者出血、腹水、胸腔积液等并发症的发生和死亡情况；RFA术后1个月复查CT或MRI和甲胎蛋白（AFP），计算RFA的完全消融率。

62个病灶的超声和CT或MRI图像的融合用时5~20 min，平均7.5 min，图像融合成功率为100%。1例患者于RFA术后2 d出现右侧胸腔大量积血伴轻度胸闷等症状，行右侧胸腔穿刺置管引流4 d后超声复查提示胸腔积液消失；14例患者术后2 d复查提示少量右侧胸腔积液或少量腹水，1~2周后超声复查提示积液或腹水消失；无RFA相关死亡病例。术后1个月，53例患者共58个病灶复查CT或MRI，提示病灶均消融完全，完全消融率为100%。术前AFP升高的10例患者术后1个月复查AFP<20 μg/L。

实时虚拟导航系统应用于超声无法明确显示的肝癌病灶RFA治疗，是一种安全有效的技术，可作为RFA的辅助手段。

To evaluate the clinical value of real-time virtual sonography navigation in radiofrequency ablation(RFA) of hepatocellular carcinoma (HCC) invisible in B-mode ultrasound.

Sixty-two HCC lesions in 54 patients in the Third Affiliated Hospital of Sun Yat-sen University from October 2010 to March 2012, diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI) but invisible in B-mode ultrasound, were studied prespectively. Local ethical committee approval had been received and that the informed concent of all participating subjects was obtained. Fifty-four patients underwent RFA, guided by real-time virtual sonography navigation. The image fusion of ultrasound and CT or MRI and the position match time was observed and successful fusion rate was calculated. Complications such as bleeding, ascites and pleural effusion and death were observed during and after RFA. All the patients received CT or MRI and serum alpha-fetoprotein (AFP) test at one month after RFA to check whether the HCC lesions had been completely ablated.

The image fusion was successfully performed in all the 62 lesions with successful rate of 100% (62/62). The average time spent on image fusion was 7.5 minutes (5 to 20 minutes). One patient complained of chest tightness due to heavy hemothorax. Catheter was applied for drainage and removed 4 days later after ultrasound revealed no fluid in the chest cavity. Fourteen patients had asymptomatic pleural effusion or ascites 2 days after ablation which disappeared in 1 to 2 weeks. RFA related death was not found. And CT or MRI one month after RFA showed that all the other 58 HCC lesions had been completely ablated with a 100% ablation rate. AFP declined below 20 μg/L in the 10 patients whose AFP raised before RFA.

The real-time virtual sonography navigation can be applied in the RFA of HCC which is invisible in B-mode ultrasound. It can be a safe and effective supplementary for RFA.