目的：探讨新型超声造影剂与实时灰阶造影匹配成像技术观察肝肿瘤的灌注过程及回声变化规律，探讨其对肝恶性肿瘤的诊断价值。方法：35例超声不能完全明确诊断或漏诊的肝占位患者，26例经手术或穿刺病理确诊，9例为造影CT、磁共振等临床资料证实，恶性肿瘤占28例。采用第二代新型造影剂SonoVue以及Technos DU6实时超声造影匹配成像技术。造影剂注射方法分别采用静脉快速团注法和慢注法两种。首先观察了正常肝、肝硬化注射造影剂后各个时相出现的时间及峰值，在此基础上观察了肝占位病变的造影剂灌注过程。结果：显示典型的原发性肝癌23例均发生动脉早期强化，21例（91%）呈快速消退即“快进快出”型，另2例<2cm的高分化小肝癌表现为动脉早期强化，但消退缓慢。肝转移性肿瘤5例表现多样，呈动脉期或门脉期环状强化或不同程度强化，消退可快可慢。肝血管瘤3例动脉期瘤内无强化，门静脉期呈向心性填充增强，持续时间长，数分钟后消退。对原发性肝癌23例进行了两种不同注射方法的比较，发现团注法使肝癌病灶更快达到增强峰值，更有利于肝癌特征的显示。本组中31例进行了超声造影前、造影后、增强CT 的诊断结果比较，肿瘤病灶的显示分别为76灶、99灶、75灶。11例恶性肿瘤病灶数目较造影前增多，其中87%（20/23）为3～10mm小病灶。另5例显示原病灶范围较前增大。结论：新型超声造影技术对肝占位病变的定性诊断明显优于常规超声；在显示肿瘤数目尤其发现微小病灶方面更优于增强CT，从而极大地提高了超声对肝占位病变的诊断价值。

目的：讨经皮射频治疗近消化管肝肿瘤时肠灼伤、肠穿孔发生的原因及预防策略，评价临床应用效果。方法：有手术切除史或其他治疗等原因不宜接受再手术的邻近消化道肿瘤55例59个病灶，制定相应的附加方法及治疗后预防措施进行治疗，并进行超声、CT随访。结果：经皮射频治疗后3～72h内持续不同程度腹痛者占38.2%（21/55例），其中48例治疗后7天内行超声或CT检查，右上腹显著疼痛、肠壁增厚水肿者占25%（12/48例），12.5%（6/48例）肠壁增厚显著，并在肝肠之间有少量积液；12例有右上腹手术或邻近肠管区域肿瘤的2～3 次射频治疗病史，其中2例为胆肠吻合术后。2～3周后10例疼痛症状缓解，2例持续性右上腹不适隐痛达4～6个月。3个月后超声或CT 检查，8例（14.5%）显示肠粘连，无1例发生肠穿孔。本组病例肿瘤1次射频消融成功率达89.8%（53/59灶），治疗后复发率达15.3%（9/59灶），其后有11例（11/55，20.0%）采用手术切除或术中RF等方法再治疗。结论：上腹手术及邻近肠管区域局部反复射频治疗是RF 易发生肠壁灼伤的危险因素；重视预防策略，可有效减少肠穿孔并发症的发生。

Background Introperitoneal hemorrhage is one of the most common complications of radiofrequency (RF)ablation of hepatic tumors. This study was designed to investigate the reason and management of intraperitoneal hemorrhage occurred during or after percutaneous RF ablation of hepatic tumors. Methods Three hundred and fifty-six patients with hepatic tumors have been treated at 592 procedures of ultrasound guided RF ablation. Intraperitoneal hemorrhage occurred in 5 patients(0.8%). The reasons and management of intraperitoneal hemorrhage in these 5 cases were retrospectively analyzed. Results Two patients with liver metastasis and one hepatocellular carcinoma (HCC) patient suffered from hemorrhage during the RF treatment. Two patients with recurrent HCC after surgery developed hemorrhage 20 minutes or 4 hours after RF treatment. One case of hemorrhage was due to the inappropriate electrode positioning induced liver laceration while treating a 1cm liver metastasis near the liver capsule. One was due to the injury of a small vessel by the RF needle in another liver metastasis patient. Three cases were due to tumor rupture with two cases induced by cough or position change after treating large protruding HCC lesions. Four (80%) of the 5 cases of hemorrhage were rapidly identified by ultrasound. The causes and sites of bleeding during the RF treatment in three cases were confirmed through ultrasound, which were successfully treated using RF coagulation to achieve hemostasis of the bleeding site. Two patients with post-ablation hemorrhage recovered in one hour and 24 hours, respectively after given blood transfusion and other conservative measures. No surgical intervention was required. Two patients died of wide spread metastasis 23-36 months afterwards and the other three patients have lived for 18-25 months to date. Conclusions It is important to perform close monitoring during and after RF ablation in order to identify intraperitoneal hemorrhage in time. RF ablation of the bleeding sites was a simple and effective management when the bleeding site could be confirmed by ultrasound. The hemorrhage due to the rupture of large and protruding liver tumors could be serious and should be considered as contraindication for RF treatment.

目的：超声引导对射频消融治疗后复发率较高的>315cm肝肿瘤，通过数学模型计算及临床治疗经验，制定术前治疗方案，并与非计算治疗方法比较，评价肿瘤消融治疗效果。方法：研究对象为肝癌及肝转移癌共125例135个肿瘤，大小3.6～7.0cm（417±0.9cm），临床分期Ⅲ～Ⅳ期者占89.6%（112/125例）。其中22例（23灶）为开展射频消融早期治疗的病例，称非计算组，余103例（112灶）为根据本计算方案治疗的病例称计算组。计算组为用多个消融灶治疗的肿瘤，按照球体数学覆盖原理，建立正棱柱体和正多面体数学模型并推导公式进行计算，获得覆盖不同大小类球体肿瘤所需的最少消融灶数目及消融定位模式。本研究还制定了实际应用的布针操作程序。结果：临床治疗结果显示，计算组肿瘤治疗成功率达88.4%（99/112 灶），局部复发率为25.9%（29/112灶），预测平均无复发时间为1715个月；非计算组病例，肿瘤治疗成功率为5212%（12/23灶）（P<0.01），局部复发率为5615%（13/23灶）（P<0.05），预测平均无复发时间为1119个月（P<0.05）。结果显示计算组疗效明显优于非计算组。结论：本研究为较大肝肿瘤射频消融治疗方案的制定，提供了理论依据并可指导临床应用，治疗结果显示可有效提高肝脏大肿瘤治疗水平，减少复发，因此是有效可行的。