| Objective:Apply contrast-enhanced ultrasound (CEUS) in preoperative, intraoperative and postoperative of percutaneous ethanol injection (PEI) for hepatic carcinoma, to probe the quantitative methods of PEI for hepatic carcinoma and investigate the clinical value of CEUS.Materials and Methods:38patients,28males and10females; aged51to79, average62.2, with hepatic carcinoma underwent PEI, including32patients with hepatocellular carcinoma(HCC),2with intrahepatic cholangio carcinoma (ICC) and4with metastatic liver cancer (MLC). All patients underwent CEUS before ablation for recording the location, size and blood supply of the nodules of hepatic carcinoma and then planning the entry point, the methods of inserting needles and the volume of anhydrous alcohol. Intraoperative CEUS was applied to guide locating and inserting needles. From deep to shallow, from dangerous margin to safe center, anhydrous alcohol was inserted slowly according to the depth and location of needles. After inserting, the alcohol diffusion range was observed to diffuse over the margin for more than1.0cm. The vital signs during operation was monitored. To assess the therapeutic efficacy and liver injury, all patients were observed with CEUS, liver fuction and tumor markers in a week after PEI. After reevaluation, the patients would be considered if re-undergoing PEI was needed. The number of PEI treatment, the total amount of needles, the volume of anhydrous alcohol, adverse reactions, the0.5-,1-year survival rates and recurrent rates were recorded.Results:1.100PEI treatments were underwent,297needles and752ml of anhydrous alcohol were used. The number of PEI treatment(N), the amount of needle(M), the volume of anhydrous alcohol (V) with the largest diameter of nodules of hepatic carcinoma (D) were positively significant correlation. The regression equations were used as follows:N=1.453D-0.9889(R=0.811, P＜0.001), M=5.613D-6.173(R=0.823, p＜0.001), V=8.022D-0.203(R=0.631, P＜0.001).2. The preoperative CEUS was better than normal ultrasound in judging tumor size and the range of infiltration.10cases of normal ultrasound couldn’t show clearly, and the other28cases showed significantly smaller tumor size by normal ultrasound. The postoperative CEUS could show active part of blood supply in nodules of hepatic carcinoma that could guide anhydrous alcohol to therapeutic targets which normal ultrasound couldn’t. Nodules of hepatic carcinoma would change in ultrasonogram after PEI that made it hard to jugde inactivation and recurrence nodules of hepatic carcinoma by normal ultrasound. Postoperative CEUS could make correct evaluation of the efficacy of PEI by showing blood supply of liver parenchyma and nodules of hepatic carcinoma.3. There was no serious adverse reaction happened during operation. The main adverse reaction included pain(78.9%),liver dysfunction(15.8%), fever(21.1%), hypohepatia (16.7%), abdominal discomfort and vomiting(16.7%).4. After treatment, the number of tumor markers of all HCC patients were declined,87.5%were turned to negative, the number of tumor markers were turned to negative in1patient of ICC, were declined in the other ICC. The number of tumor markers were declined in all patients of MLC by different degrees.5. These38patients had0.5-,1-year survival rates of97.3%、89.5%, and recurrent rates of5.3%、13.2%.Conclusion:CEUS can assess tumor size, the range of infiltration, and local tissue extension accurately before PEI, then help to plan the operation methods. It could provide close guiding, ablate lesions precisely during operation and be used for postoperation assessment. CEUS can guide PEI for hepatic carcinoma quantitatively, also might improve the therapeutic efficacy of PEI for hepatic carcinoma. |
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