gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z...

48
Ɇɹɫɬɨɬɨ ɧɚ ɢɧɬɪɚɨɩɟɪɚɬɢɜɧɚɬɚ ɟɯɨɝɪɚɮɢɹ ɩɪɢ ɞɢɚɝɧɨɫɬɢɤɚ ɧɚ ɱɟɪɧɨɞɪɨɛɧɢ ɥɟɡɢɢ ɂɜɚɣɥɨ ȼɴɠɚɪɨɜ Ʉɥɢɧɢɤɚ ȼɴɬɪɟɲɧɢ ɛɨɥɟɫɬɢ ɆȻȺɅ – ȼɚɪɧɚ ɤɴɦ ȼɆȺ

Transcript of gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z...

Page 1: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

Page 2: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

Some Like It Hot

ь

Page 3: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

( ) -

- .

Joo I. et al. The role of intraoperative

ultrasonography in the diagnosis and

management of focal hepatic lesions.

Ultrasonography. 2015 Oct;34(4):246-57.

Page 4: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

Ч

, ,

.

Page 5: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

,

,

.

Page 6: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

, / :

( ) -

( )

Page 7: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

( / )

( )

Page 8: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

, , -

.

Lok AS et al. Gastroenterology 2010

Page 9: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

80- 20

:

-

Kane RA. J Ultrasound Med. 2004

Page 10: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

Ч

“ ”

50%

.

Caralt M. Ann Surg Oncol. 2008

.

Cerwenka H. Clinical Imaging, 2006

Page 11: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

, 60%

,

- 10

. Hekimoglu. Eur. J Radiol. 2011

10% 40%

.

Torzilli G. Surg Oncol Clin N Am.2003

Page 12: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

.

Page 13: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

.

, - ,

Joo I. Ultrasonography. 2015

Page 14: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

Professor Masatoshi Makuuchi

Page 15: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

ля а И Е

1)

2)

,

,

< 1 .

Conlon R et al. Eur J Ultrasound 2003

Page 16: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

г щ е ле 104 ац е а Ч

я я

КТ

ИОЕ

, n=61

101

154

260

, n=12

20

32

60

, n=11

20

18

32

, n=7

6

7

22

, n=6

7

12

40

Др. Ма иг е

ту р, n=7

12

17

19

Page 17: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ
Page 18: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

3) -

,

.

Fioole B et al. Eur J Radiol 2008

Page 19: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

:

1) ,

2)

3) ( - ) 4)

5) ( )

6)

7)

Page 20: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

4)

Couinaud,

,

.

Couinaud C. Presse Medicale. 1954

Page 21: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ
Page 22: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

61 -

щ

I II III IV V VI VII VIII

11 5 22 15 33 12 3 101

1 20 11 33 27 31 18 13 154

4 33 30 50 39 46 27 31 260

Page 23: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

5)

.

6)

.

Kane RA. Ultrasound Med. 2004

Page 24: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

,

.

,

.

Makuuchi M. Proceedings of the 32nd Meeting of the

Japan Society of Ultrasonics in Medicine 1977

Page 25: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

я

я

Page 26: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

7) ,

.

.

,

.

Torzilli G et al.. Annals of Surgery 2008

Page 27: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

я

. я

Page 28: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

8)

.

Fischer J. Mastery of surgery. 2007

Page 29: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ
Page 30: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

9) –

Page 31: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

10)

Page 32: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

,

. -

Page 33: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

,

,

.

Page 34: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

,

.

Mortensen MB et al. Surg Endosc. 2009

,

Marcal LP et al. World J Radiol. 2013

Page 35: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

10)

27% 55% ,

. Satoi S et al. Pancreas 2007

Page 36: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

104

Ч , Ч

27/104 (26,22%) 22/104

(21,15%).

< 20 mm.,

166 433 <

20mm., 11 17.

1 (0,96%)

.

Page 37: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

11)

19% 65%

. Torzilli G. Ann Ital Chir. 2008

104

Ч

47/104 (45,64%).

Page 38: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

12) -

92.3% 98%

95%.

Wildi S.M. J.Clin. Ultrasound 2008

Page 39: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

В В , , А

А А А ВАЩА

Sensitivity

Specificity

+PV

-PV

75,57% 61,64% 95,12% 15,95%

78,28% 65,34% 97% 18,67%

100% 72,73% 97,76% 100%

Page 40: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

14. А - А

Page 41: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

- И Е И Е И

Въ ар . Р т л ия и ра и л ия 2012

Page 42: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

Arita . , 32- ,

, 28

, -

Sonazoid

12 , 11

.

Arita J et al. Ann Surg Oncol. 2014

Page 43: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

- Sonazoid

, -

,

,

,

Joo I. Ultrasonography. 2015

Page 44: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

.

Omichi .

8%

.

Omichi K et al. Br J Surg. 2015

Page 45: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

,

,

Inoue Y et al. Surgery. 2010

Omichi K et al. Br J Surg. 2015

HCC

Kato K et al. Liver Int. 2008

Page 46: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

,

-

,

,

.

Correa-Gallego C et al. Acad Radiol. 2014

Page 47: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ

, я

. я ,

я , ,

.

“ ”

,

.

Page 48: gZlZ oh]jZnbyijb^bZ]ghklbdZgZ q jgh^jh[gbe abbhp_gdZ gZ fZedb nhdZegb e_abb \ q_jgby ^jh[ b fh`_ ^Z ih\eby_ gZ ba[hjZ gZ objmj]bqgZlZ kljZl_]by b ^Z ^h\_^_ ^h ih -]heyfZ hgdheh]bqgZ