彩色多普勒超声检测肝脏血流参数对肝细胞肝癌术后复发的预测价值研究

发布时间：2018-05-19 06:04

本文选题：肝细胞肝癌 + 彩色多普勒超声　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨彩色多普勒超声检测肝细胞肝癌(Hepatocellular Carcinoma,HCC)患者门静脉、肝动脉血流参数对HCC的诊断及对影响其预后的危险因素的评估意义,以及对患者手术切除后早期复发的预测作用。方法:收集2015年9月-2016年12月于广西医科大学附属肿瘤医院肝胆外科住院并经手术病理证实为HCC的患者共229例,另收集健康体检者234例作为对照组。彩色多普勒超声检查获取体检者及HCC患者手术前及手术后的门静脉血流平均流速(V)、门静脉血流量(Q)、门静脉内径(D)及肝动脉搏动指数(PI)、肝动脉阻力指数(RI),分析这些参数在HCC患者组与对照组之间的差异、在HCC患者术前与术后的差异,及在HCC患者各影响预后危险因素分组之间的差异,以及术后早期复发组与无复发组之间的差异。结果:1、HCC患者组门静脉流量、内径明显大于对照组,肝动脉PI明显小于对照组,HCC患者术前门静脉流速明显大于术后,术前门静脉内径、肝动脉PI、RI明显小于术后(P0.05);2、HCC患者有癌栓组术前的门静脉内径、门静脉流量及肝动脉RI明显大于无癌栓组,BCLC C期组术前门静脉流量、内径及肝动脉RI明显大于BCLC B期组(P0.05);3、HCC复发组术前肝动脉RI、PI明显小于无复发组(P0.05);PI值的ROC曲线下面积为0.659(P=0.007),RI值的ROC曲线下面积为0.642(P=0.016);PI值为1.05时为最佳临界值,诊断复发的敏感性为68.8%,特异性为66%;RI值为0.645时为最佳临界值,诊断复发的敏感性为68.8%,特异性为58.8%。结论:多普勒超声检测门静脉、肝动脉血流参数能对HCC肿瘤的发生发展及预后进行监测,1、门静脉内径的增宽、流量的增加及肝动脉PI减低可作为诊断HCC的参考;2、门静脉内径、流量及肝动脉RI增大能作为反映HCC癌栓的无创评估指标;3、HCC患者术前肝动脉PI、RI值越低,术后复发的可能性越大,PI值1.05或RI值0.645可作为预测HCC术后早期复发的参考值,具有较好的敏感性及特异性。
[Abstract]:Objective: to investigate the value of color Doppler ultrasound in detecting portal vein and hepatic artery blood flow parameters in patients with hepatocellular carcinoma (HCC) and evaluate the prognostic risk factors of HCC and predict the early recurrence after surgical resection. Methods: 229 cases of HCC were collected from September 2015 to December 2016 in Department of Hepatobiliary surgery, affiliated Cancer Hospital of Guangxi Medical University, and 234 healthy persons were selected as control group. Color Doppler ultrasound (CDFI) was used to determine the mean velocity of portal vein blood flow before and after operation, portal vein blood flow, portal vein diameters, hepatic artery pulsatility index (Pi), hepatic artery resistance index (RI) and hepatic artery resistance index (RI) in patients with HCC before and after operation. The difference of parameters between HCC group and control group, The difference between pre-and post-operation in HCC patients, among the groups of prognostic risk factors in HCC patients, and between the early recurrence group and the non-recurrence group after operation. Results the portal vein flow and internal diameter were significantly larger in the patients with HCC than those in the control group, and the Pi of hepatic artery was significantly lower than that in the control group. The flow rate of portal vein before operation was higher than that in the control group, and the diameter of portal vein before operation. The portal vein diameter, portal vein flow and RI of hepatic artery in patients with HCC were significantly lower than those in patients with HCC without tumor thrombus before operation, and the flow of portal vein and RI of hepatic artery were significantly higher than those of BCLC stage without tumor thrombus. The area under the ROC curve of the diameter and RI of the hepatic artery was significantly larger than that of the group with stage B BCLC B and the area under the ROC curve of 0.642P0. 01616PI was the best critical value when the Pi value of the hepatic artery was significantly lower than that of the non recurrence group. The area under the ROC curve was 0. 642P0. 016PI, and the area under the ROC curve was 0. 642P0. 016Pi, which was significantly lower than that of the non recurrence group (P0. 05, P 0. 05, P 0. 05). The sensitivity of diagnosis of recurrence was 68.8 and the specificity was 6645. The sensitivity and specificity of diagnosis of recurrence were 68.8 and 58.8 respectively. Conclusion: the hepatic artery blood flow parameters can be used to monitor the occurrence, development and prognosis of HCC tumor by Doppler ultrasound. The diameter of portal vein is enlarged, the increase of flow rate and the decrease of Pi of hepatic artery can be used as a reference for the diagnosis of HCC and the diameter of portal vein. The increase of flow rate and RI of hepatic artery can be used as a noninvasive index to evaluate HCC thrombus. The lower the RI value of hepatic artery before operation, the greater the possibility of postoperative recurrence. Pi value 1.05 or RI value 0.645 can be used as a reference value for predicting early recurrence after HCC. It has good sensitivity and specificity.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R445.1

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