HCC术后超早期复发的危险因素分析及DSA与增强CT对其诊断价值的对比研究

发布时间：2018-01-03 17:09

本文关键词：HCC术后超早期复发的危险因素分析及DSA与增强CT对其诊断价值的对比研究　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：第一部分HCC术后超早期复发的危险因素分析目的:探讨肝细胞肝癌(HCC)术后超早期复发的相关因素,从而为HCC术后超早期复发的临床预防及早期诊治提供科学依据。方法:回顾性分析河北医科大学附属第四医院2015年12月-2016年6月期间收治肝癌患者临床资料。并根据以下标准筛选:入组标准:1、初次诊为原发性肝癌,且行肝部分切除术,达到I级切除,术后病理为HCC;2、术前影像学资料齐全,未发现淋巴结转移及远处转移;3、术前肝功能Child-Pugh分级为A级或部分肝功能较好的B级。排除标准:1、之前诊为肝癌,本次为复发患者;2、术前行化疗、TACE、消融等治疗。从术后第1天算起,每位患者随访期为6个月。术后超早期复发标准:术后6个月内复发。本研究对患者一般资料(性别、年龄)、影像学资料(肿瘤大小、位置及数量)、检验学资料(包括HBsAg、乙肝病毒载量(HBV-DNA)、血清AFP、术前γ-谷氨酰转肽酶(GGT)、谷丙转氨酶(ALT)、总胆红素(TIBL)、中性粒细胞计数/淋巴细胞计数(NLR))、病理学资料(肝硬化程度、肿瘤有无完整包膜、卫星灶及肉眼门脉瘤栓)及术中治疗资料(手术切缘、术中有无输血、腹水、肝癌破裂出血及第一肝门阻断时间)等相关临床病例因素,共21项可能影响肝细胞肝癌术后超早期复发的相关因素进行统计学分析,上述变量采用单因素和多因素logistics回归分析。共筛选出符合上述入选及排除标准病例共146例;超早期复发组,共55例;剩余91例归入未复发组。结果:单因素Logistic回归分析结果表明:性别、肿瘤大小、肿瘤数目、HBV-DNA、血清AFP、术前GGT、肿瘤周围有无卫星灶、肉眼门脉瘤栓、有无肝癌破裂出血9项因素对术后超早期复发有影响,其差异均有统计学意义(P0.05)。多因素Logistic回归分析结果发现:性别、肿瘤数量、血清AFP、HBV-DNA、肉眼门脉瘤栓、有无肝癌破裂出血对HCC术后超早期复发影响较大,差异有明显统计学意义(P0.05)。第二部分DSA与增强CT对HCC术后复发的诊断价值的对比研究目的:对比肝动脉数字减影血管造影(DSA)及增强CT对HCC术后复发的诊断价值。方法:收集河北医科大学第四医院2015年12月-2016年6月收治的肝癌患者,入院诊断为原发性肝癌,且行肝部分切除术,术后病理为HCC。随访期为6个月,并收集其随访期内增强CT及DSA检查图像。术后随访期内复发患者,选取检出复发当次增强CT及DSA检查图像行对比研究;未复发患者,选取随访期内末次增强CT及DSA检查图像行对比研究。所选对比影像学资料,间隔不超过7天。共134名入组患者,金标准诊断为复发共55例,未复发患者共79例,随访期共有127名患者行增强CT检查,总计216次,单个病人随访期内最多行4次;共109名患者行DSA检查,总计141次,单个病人随访期内最多共行3次。结果:按照上述选取标准,共选取123次增强CT及105次DSA评价两种检查方法的优劣,其中增强CT检查诊断的敏感性为80.7%,特异性为97.2%,准确性为90.2%。与之相比DSA检查诊断的敏感性为97.9%,特异性为91.4%,准确性为94.3%。增强CT及DSA检查的ROC曲线下面积分别为0.866(95%CI 0.785-0.948)和0.939(95%CI 0.883-0.994)。结论:1患者性别、HBV-DNA、术前血清AFP、GGT、NLR、肿瘤大小、数目,肿瘤周围是否存在“卫星灶”、有无肉眼门脉瘤栓及肝癌破裂出血可能是HCC术后超早期复发的影响因素。2患者性别、HBV-DNA、术前血清AFP、肿瘤数量、有无肉眼门脉瘤栓及肝癌破裂出血是HCC术后超早期复发的独立危险因素。3肝动脉DSA及增强CT检查对HCC术后复发均有较高的敏感性、特异性及准确性。对HCC术后复发的诊断价值,肝动脉DSA检查优于增强CT。
[Abstract]:The first part of the risk factors after HCC ultra early recurrence analysis objective: To investigate the hepatocellular carcinoma (HCC) related factors of postoperative early recurrence, provide scientific basis for clinical prevention and early diagnosis and early recurrence of super after HCC. Methods: retrospective analysis of clinical data of December 2015 in the Fourth Affiliated Hospital of Hebei Medical University during June -2016 from patients with liver cancer. According to the following criteria: screening group: 1, the initial diagnosis of primary liver cancer, and underwent partial hepatectomy, level I resection, postoperative pathological diagnosis was HCC; 2, preoperative imaging information Liao Qiquan, found no lymph node metastasis and distant metastasis; 3, preoperative liver function Child-Pugh grade B or a part of liver function better. Exclusion criteria: 1, before the diagnosis of hepatocellular carcinoma, the recurrent patients; 2, preoperative chemotherapy, TACE ablation therapy. After first days from the date, all the patients were followed up for 6 Month after surgery. Ultra early recurrence criteria: recurrence within 6 months after the operation. The research on the general data of patients (gender, age), imaging data (tumor size, location and number), test data (including HBsAg, hepatitis B virus (HBV-DNA), preoperative serum AFP, gamma Valley transpeptidase (GGT), alanine aminotransferase (ALT), total bilirubin (TIBL), neutrophil / lymphocyte count (NLR)), pathology (liver cirrhosis, tumor without complete capsule, satellite lesions and macroscopic portal vein thrombosis) treatment data and intraoperative incision (margin, intraoperative blood transfusion, ascites, liver rupture and Pringle time) and other related clinical factors, a total of 21 possible factors related to hepatocellular carcinoma after ultra early recurrence were analyzed statistically, the variables using univariate and multivariate logistics regression analysis were screened out and meet the exclusion. The selected The standard 146 cases; ultra early recurrence group, a total of 55 cases; the remaining 91 cases in the non recurrent group. Results: univariate Logistic regression analysis showed that sex, tumor size, tumor number, serum HBV-DNA, AFP, GGT before operation, there is no satellite lesions around the tumor, portal vein tumor thrombus with naked eye, no rupture of hepatocellular carcinoma: 9 factors of early postoperative recurrence, the differences were statistically significant (P0.05). Logistic regression analysis results showed: gender, tumor number, serum AFP, HBV-DNA, portal vein tumor thrombus with the naked eye, no liver rupture of blood on the postoperative recurrence of HCC early influence and there was a significant difference (P0.05). The second part DSA and enhanced CT for the purpose of comparison of the diagnostic value of recurrence after HCC: comparison of hepatic artery digital subtraction angiography (DSA) and enhanced the value of CT in the fault diagnosis of HCC recurrence after surgery. Methods: from the Hebei Medical University Four December 2015 -2016 year in June from HCC patients, diagnosed as primary liver cancer, and underwent partial hepatectomy, postoperative pathological HCC. follow-up period of 6 months, and collect the follow-up enhanced CT and DSA imaging. Recurrence during the follow-up period after surgery, recurrence time when selecting detection enhanced CT and DSA examination for comparative study of image; no recurrence at the end of the follow-up period, selection of enhancement of contrast image of CT and DSA examination. The selected contrast imaging data, at intervals of not more than 7 days. A total of 134 patients were enrolled as the gold standard for the diagnosis of recurrence in 55 cases, no relapse patients the follow-up period in 79 cases, a total of 127 patients underwent enhanced CT examination, a total of 216 times, a single patient follow-up period up to 4 times; a total of 109 patients underwent DSA examination, a total of 141 times, a single patient follow-up period up to a total of 3. Results: according to the selection criteria, a total of 123 times enhancement CT and 105 Two kinds of method in the evaluation of the merits of DSA, which enhanced the sensitivity of CT diagnosis was 80.7%, the specificity was 97.2%, accuracy was 90.2%. sensitivity compared with the diagnosis of DSA was 97.9%, the specificity was 91.4%, accuracy was 94.3%. CT enhanced ROC curve area and DSA examination were 0.866 (95%CI and 0.785-0.948) 0.939 (95%CI 0.883-0.994). Conclusion: 1 patients with gender, preoperative serum AFP, HBV-DNA, GGT, NLR, tumor size, tumor number, around whether there is "satellite focus", there is no gross portal vein tumor thrombosis and hemorrhage of ruptured hepatocellular carcinoma may be.2 patients gender, influencing factors of postoperative early recurrence of HCC super HBV-DNA, preoperative serum AFP, tumor number, there is no gross portal vein tumor thrombosis and rupture of liver cancer were independent risk factors of.3 hepatic artery DSA HCC after ultra early recurrence and enhanced CT sensitivity to recurrence were higher after HCC, specificity and accuracy In the diagnosis of postoperative recurrence of HCC, the DSA examination of the hepatic artery is superior to that of the enhanced CT.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R730.44

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