原发性肝细胞癌病灶形态学的CT研究

The Morphological Study of Hepatocellular Carcinnoma Focus on CT

对232例原发性肝细胞癌病灶的术前CT表现进行分析。以病灶的形态、轮廓、边缘作为指标,将肝癌病灶术前CT表现分为3种类型:类圆膨胀生长型(Ⅰ型)、不规则膨胀生长型(Ⅱ型)、不规则浸润型(Ⅲ型)。对不同CT分型与手术病理结果对照观察发现:从Ⅰ型到Ⅲ型,肿瘤的肝内播散率(分别为18.6％、37.7％、47.8％)、肝外淋巴结转移率(分别为0、7.79％、23.18％)、门静脉瘤栓形成率(分别为2.3％、20.8％、46.4％)依次增高,包膜形成比例依次明显减少(分别为67.4％、27.3％、5.28％),统计学处理差别均具显著意义。从临床观察来看,各型大肝癌的切除率及疗效从Ⅰ型到Ⅲ型逐渐减低、变差;生存分析提示:从Ⅰ型到Ⅲ型病人的预后逐渐明显变差。说明CT分型能反映肝癌病灶的整体生物学特性,有病理及临床意义。本文还讨论了CT分型对临床治疗的可能指导作用。

The preoperative CT appearances of hepatocellular carcinoma(HCC) lesions in 232 cases were analyzed. In our study,according to the CT features in shape,outline and margin of tumor,HCC Was divided into 3 types : Type Ⅰ -roundish expansive growth type (REG TYPE) ;Type Ⅱ-iregular expansive growth type(IEG TYPE) ;Type Ⅲ-----Irregular infiltration growth type(IIG TYPE). Comparing different CT types with findings at laparotomy or pathological specimens,it showed that the intrahepatic tumor dissemination rate of type Ⅰ, type Ⅱ and type Ⅲ were 18. 6% ,37. 7%, 47. 8% respectively. The lymph node metastasis rate were 0,7. 7% ,23. Irrespectively. The portal vein tumor thrombus formation rate were 2. 3%, 20. 8%, 46. 4% respectively. The proportion of encapsulation (67. 4%,27. 3%,5. 28% respectively) apparently decreased from type Ⅰ to type Ⅲ in turn. These differences achieved statistical significance. From type Ⅰ to type Ⅲ,large tumor resection rate decreaseed, and the prognosis was getting poor and poor. Survival analysis (Cox's mode ) showed survival difference from type Ⅰ to etype Ⅲ was significient. Therefore, CT classification can be used to evaluate the entire biological behavior of HCC lesions and might have pathological and clinical significance. Hepatocellular carcinoma (HCC) Type.CT