倪 娟 虞梅▲梅 琪 徐祥勇 沙红芳翟凌云韩莹莹张 菁.上海市徐汇区大华医：超声影像科，上海0037；.上海市徐汇区大华医：肝科，上海0037

    超声造影监测肝硬化增生结节和发现非常早期肝癌的应用价值

    倪娟1虞梅1▲梅琪1徐祥勇1沙红芳1翟凌云1韩莹莹1张菁2

    1.上海市徐汇区大华医：超声影像科，上海200237；2.上海市徐汇区大华医：肝科，上海200237

    目的探讨肝脏超声造影监测肝硬化增生结节和发现非常早期肝癌(HCC)的临床应用价值。方法选择2007年2月～2015年11月上海市徐汇区大华医：就诊的122例乙型肝炎肝硬化患者213个肝硬化增生结节进行定期常规超声检查，根据肝内结节在常规超声中大小、形态的改变，进行追踪目标定位的肝超声造影检查鉴别诊断其良恶性。结果超声造影监控中213个肝硬化增生结节中在不同时间段内发现非常早期HCC病灶33个(直径≤2 cm)，异型增生结节21个。33例HCC中，男75.8%(25例)，女24.2%(8例)，外源性乙肝感染者72.7%(24例)，母婴感染乙肝史27.3%(9例)，肝癌家族史21.2%(7例)，外源性乙肝感染者的HCC发病率显著高于母婴感染乙肝者和肝癌家族史，差异有统计学意义(P<0.05)。其中<1 cm占27.3%(9个)，“快进慢出”型发生率66.7%(6/9)明显高于“快进快出”型33.3%(3/9)，差异有统计学意义(P<0.05)；1～2 cm占73.7%(24个)，“快进快出”型发生率75.0%(18/24)明显高于“快进慢出”型25.0%(6/24)，差异有统计学意义(P<0.05)。结论超声造影可对肝硬化增生结节进行长期的跟踪监测，以达到发现非常早期肝细胞肝癌的目的。

    肝硬化；超声造影；监测；非常早期肝癌

    [Abstract]Objective To investigate the c1inica1 va1ue of contrast-enhanced u1trasound(CEUS)in monitoring and detecting the very ear1y hepatoce11u1ar carcinoma(HCC).Methods From February 2007 to November 2015,in Dahua Hospita1 of Xuhui District,122 HBV-re1ated hepatocirrhosis patients with 213 dysp1astic nodu1e 1esions were routine1y examined and fo11owed up by conventiona1 u1trasound(US)and CEUS for monitoring suspicious HCC 1esions,differentia1 diagnosis of benign or ma1ignant hepatic 1esions was made on the basis of its appearances on conventiona1 u1trasound and CEUS.Results There were 33 very ear1y HCCs(sma11er than 2.0 cm)and 21 dysp1astic nodu1es among 213 suspicious 1esions detected and diagnosed with CEUS.They were 75.8%(25 cases)ma1es and 24.2%(8 cases)fema1es. Among 33 very ear1y HCC patinets,there were 72.7%(24 cases)cases with extrinsic infected hepatitis B,27.3%(9 cases) cases with mother-to-chi1d infection and 21.2%(7 cases)cases with fami1y history of HCC.The incidence of HCC in extrinsic infected hepatitis group was significant1y higher than that in mother-to-chi1d infection and fami1y history groups,the difference was statistica11y significant(P<0.05).Among 9(27.3%)HCC patinets sma11er than 1 cm,the type of“quick wash-in and s1ow wash-out”appeared in 66.7%(6/9)cases on CEUS,which was significant1y higher than the type of“quick wash-in and quick wash-out”cases of 33.3%(3/9),the differences were statistica11y significant (P<0.05).Among 24 HCC(73.7%)patinets sized 1～2 cm,the type of“quick wash-in and quick wash-out”appeared in 75.0%(18/24)cases on CEUS,which was significant1y higher than the type of“quick wash-in and s1ow wash-out”cases of 25.0%(6/24),the differences were statistica11y significant(P<0.05).Conclusion CEUS p1ays an important ro1e in the monitoring patients with cirrhotic nodu1es to detect very ear1y HCC. ......