多层螺旋CT血管造影对原发性肝癌动静脉瘘和肝外供血动脉评估价值

发布时间：2018-06-26 14:28

本文选题：原发性肝癌 + 多层螺旋CT血管成像　；参考：《中华肿瘤防治杂志》2017年11期

【摘要】：目的原发性肝癌(primary liver cancer,PLC)是我国常见的恶性肿瘤之一,治疗尤其是介入治疗前,需详细了解肝脏及肝脏肿瘤的血管准确解剖。多层螺旋CT血管造影(multislice spiral CT angiography,MSCTA)具有扫描速度快,覆盖范围广,后处理技术成熟等优势,本研究旨在探讨MSCTA在PLC患者肝动脉-门静脉瘘(hepatic artery-portal vein fistula,HAPVF)及肝外供血动脉术前评估中的临床应用价值。方法回顾性分析2014-10-01-2015-10-01山东大学附属山东省肿瘤医院介入科收治的90例PLC患者MSCTA和数字减影血管造影(digital subtraction angiography,DSA)临床资料,评价HAPVF和肝动脉-肝静脉瘘(hepatic artery-hepatic vein fistula,HAHVF)发生率及其与肿瘤大小、部位和肝硬变程度的关系;肝外供血动脉与毗邻肿瘤的关系。以DSA结果为金标准,分析MSCTA评估PLC血管异常的准确性。结果 90例PLC患者中,共发现HAPVF 48例,发生率为53.3%,其中A组0例,B组5例(10.4%),C组17例(35.4%),D组26例(54.2%);中心型28例(58.3%),周围型20例(41.7%);Child-Pugh A级34例(70.8%),Child-Pugh B级12例(25%),Child-Pugh C级2例(4.2%)。HAHVF 4例,发生率为4.4%。二元Logistics回归分析显示,肿瘤大小及肝硬变程度是HAPVF的独立危险因素,P0.05。MSCTA共检出HAPVF 45例,中央型28例,准确率为100.0%(28/28);周围型17例,准确率85.0%(17/20);总体准确率为93.8%(45/48),与DSA结果进行比较,差异无统计学意义,χ~2=3.097,P0.05。19例患者存在24条肝外供血动脉,均发生于C组和D组,周围型和中心型分别为87.5%和12.5%,MSCTA发现22条,两者比较差异无统计学意义,χ~2=2.087,P0.05。结论 MSCTA技术可准确显示HAPVF及肝外供血动脉,肿瘤大小及肝硬化分级是肝动-静脉瘘的独立危险因素。肝外供血动脉多发生于块状型、巨块型且位于多肝脏边缘区域的肝癌。
[Abstract]:Objective (primary liver cancer is one of the most common malignant tumors in China. Multislice spiral CT angiography (multislice spiral) has the advantages of fast scanning speed, wide coverage, mature post-processing technology, and so on. The purpose of this study was to evaluate the clinical value of MSCTA in preoperative evaluation of hepatic arterial-portal vein fistula (hepatic artery-portal vein fistula) and extrahepatic feeding artery. Methods the clinical data of 90 patients admitted to the Department of Interventional Medicine of Shandong Cancer Hospital affiliated to Shandong University from January 2014 to January 2015-01 were retrospectively analyzed. The clinical data of (digital subtraction and hepatic artery-hepatic vein arterio-hepatic venous fistula (HHVF) were evaluated. The relationship between the location and the degree of cirrhosis and the relationship between the extrahepatic blood supply artery and adjacent tumors. Using DSA results as gold standard, the accuracy of MSCTA in assessing the vascular abnormalities of PLC was analyzed. Results among 90 PLC patients, 48 cases (53.3%) were found with HAPVF, including 5 cases (10.4%) in group A, 17 cases (35.4%) in group C, 26 cases (54.2%) in group D, 28 cases (58.3%) in central type, 20 cases (41.7%) in peripheral type, 34 cases (70.8%) in Child-Pugh A grade, 12 cases (25%) in Child-Pugh B grade, 2 cases (4.2%) in Child-Pugh C grade and 4 cases in HAHVF group. Binary Logistics regression analysis showed that tumor size and degree of cirrhosis were independent risk factors of HAPVF (P0.05.MSCTA) in 45 cases, central type in 28 cases, peripheral type in 17 cases, accuracy rate in 85.0% (17 / 20), total accuracy rate was 93.8% (45 / 48). There were 24 extrahepatic supply arteries in group C and D, the peripheral type and central type were 87.5% and 12.5%, respectively. There was no significant difference between them (蠂 2 / 22.087P 0.05). Conclusion MSCTA is an independent risk factor for hepatic arteriovenous fistula. Most of the extrahepatic blood supply arteries occur in massive, massive liver cancer, which are located in the marginal region of multiple livers.
【作者单位】：山东大学附属山东省肿瘤医院影像科;山东大学附属山东省肿瘤医院放疗科;山东大学附属山东省肿瘤医院外七科;山东大学附属山东省肿瘤医院科教部;
【基金】：山东省医学科学院科技计划面上项目(2014-10,2014-15)
【分类号】：R730.44;R735.7

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