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宫颈癌同步放化疗 患者应用超声功能 成像评估疗效的价 值探析

作者:张 攀1 王 健2 王灵芝1 李 静1

所属单位:1.河南科技大学第一附属医院产科 (河南 洛阳 471000) 2.河南科技大学第一附属医院CT室 (河南 洛阳 471000)

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摘要

目的 探究宫颈癌同步放化疗 患者应用超声功能成像评估疗效的价 值。方法 选取2017年1月-2018年3月我 院收治的宫颈癌患者41例,患者均行同 步放化疗,采用超声功能成像技术检测 治疗前、治疗后1w、2w、治疗结束后功 能成像图片及弹性应变比值,分析其与 同步放化疗疗效的关系。结果 经同步 放化疗后,完全缓解者26例(63.41%), 部分缓解者15例(36.59%);治疗后宫颈 形态明显恢复,病灶减小或消失,宫颈 线连续可见;治疗前CR组肿瘤最大长径 为(38.64±7.57)mm,治疗后病灶完全消 失,PR组为(42.07±8.39)mm,治疗后为 (23.94±6.31)mm,明显低于治疗前(P <0.01);治疗后CR组弹性成像图像呈整 体绿色,PR组可见病灶中央以绿色为主, 部分可见局灶性蓝色区域;随着治疗过 程推进,病灶弹性应变比值均呈下降趋 势,CR组治疗后1w弹性应变比值开始明显 下降,较治疗前显著降低(P<0.05),PR 组治疗后2w弹性应变比值出现显著下降趋 势,与治疗前比较明显降低(P<0.05); 治疗后1w、2w、治疗结束CR组弹性应变比 值均低于PR组(P<0.05)。结论 超声功能 成像可通过早期持续监测弹性应变比值来 反映宫颈癌同步放化疗效果

Objective To investigate the value of ultrasound functional imaging in evaluation of the curative effect in patients with cervical cancer undergoing concurrent chemoradiotherapy. Methods A total of 41 patients with cervical cancer who admitted to the hospital from January 2017 to February 2018 were enrolled into the study. All patients were treated with concurrent chemoradiotherapy. Ultrasound functional imagingand the elastic strain ratio was used to detect the lesions before treatment, 1 week and 2 weeks after treatment and at the end of treatment. The curative effect of concurrent chemoradiotherapy was analyzed. Results A total of 26 patients (63.41%) had complete remission (CR) and 15 patients (36.59%) had partial remission (PR) after concurrent chemoradiotherapy. The cervical morphology recovered significantly, the lesions decreased or disappeared, and the cervical line was continuous and visible after treatment. The maximum long diameter in CR group before treatment was (38.64±7.57) mm and lesions disappeared completely after treatment. The maximum long diameter in PR group was significantly decreased after treatment [(42.07±8.39) mm vs (23.94±6.31) mm] (P<0.01). The elastic imaging results of CR group were green overall after treatment and in PR group, the central part of the lesion was mainly green, with some focal blue areas. As the treatment progressed, the elastic strain ratio of lesions showed a downward trend. The elastic strain ratio in CR group decreased significantly 1 week after treatment (P<0.05), while the elastic strain ratio in PR group decreased significantly at 2 weeks after treatment (P<0.05). The elastic strain ratios of CR group were lower than those of PR group at 1 week and 2 weeks after treatment and at the end of treatment (P<0.05). Conclusion Ultrasound functional imaging can accurately reflect the effects of concurrent chemoradiotherapy on cervical cancer by early continuous monitoring of elastic strain ratio, and it is of predictive value for evaluating the curative effect on cervical cancer.

【关键词】宫颈癌;同步放化疗;三维超 声;功能成像

【中图分类号】R73;R81

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2019.02.020

前言

宫颈癌是导致女性死亡的常见恶性肿瘤之一,主要致病因素是乳 头瘤病毒的持续感染,随着我国细胞学筛查工作的广泛开展,宫颈癌 死亡率得到有效控制,但我国宫颈癌患者占全球总患病人口1/3,发 病率仍在逐年增长,且发病群体呈年轻化趋势,给我国女性健康带来 了严重威胁[1-2]。宫颈癌常规治疗方案包括手术、放疗及化疗,手术 方案主要适用于早期宫颈癌,对IIb~IVa期失去手术指征的患者,目 前临床首选同步放化疗。实施同步放化疗治疗过程中需进行放化疗敏 感性评估并及时调整放疗照射野及化疗方案,妇科检查是最常用的评 估手段之一,但妇检具主观性,对肿瘤性质、坏死残留及深部肿瘤的 判断有一定局限性,因此难以成为精准依据指导放化疗方案的调整工 作[3]。超声弹性功能成像是一种新兴超声技术,可在组织学基础上根 据受压感兴趣部位(ROI)的变形位移表示组织硬度变化,由于良恶性肿 瘤及正常组织之间硬度差异明显,采用超声弹性功能成像可准确用于 良恶性病灶的鉴别诊断[4]。本研究采用超声功能成像技术观察宫颈癌