彩色多普勒超声对肝细胞癌合并门静脉主干癌栓患者肝固有动脉血流检测的研究

Color Doppler Ultrasound Study of the Proper Hepatic Artery Blood Flow in Hepatocellular Carcinoma with Portal Stem Vein Tumor Thrombus

目的探讨肝细胞癌合并门静脉主干癌栓时的肝动脉血流动力学变化。方法采用彩色多普勒超声对22例单纯肝细胞癌患者和26例肝细胞癌合并门静脉主干癌栓患者的肝固有动脉内径、收缩期最大血流速度以及阻力指数进行测定,并与正常对照组作对比。结果肝固有动脉内径:正常对照组0.33±0.05cm,单纯肝细胞癌组0.44±0.04cm,合并门静脉癌栓部分阻塞组0.45±0.04cm,合并门静脉癌栓完全阻塞组0.61±0.07cm。收缩期最大血流速度:正常对照组31.32±9.32cm/s,单纯肝细胞癌组66.76±20.34cm/s,部分阻塞组68.16±21.96cm/s,完全阻塞组132.65±38.84cm/s。阻力指数:正常对照组0.75±0.08,单纯肝细胞癌组0.68±0.13,部分阻塞组0.65±0.11,完全阻塞组0.55±0.10。经统计学处理,除部分阻塞组与单纯肝细胞癌组各项血流动力学参数无差异外(P>0.05),其它各组之间均存在差异(P<0.01)。结论肝细胞癌合并门静脉主干癌栓时,肝动脉血流量明显代偿性增加,阻力指数明显减低,但肝动脉血流动力学的这种改变主要取决于癌栓对门静脉主干的阻塞程度,而并不取决于门静脉癌栓的有无。

Objective To investigate the hemodynamic changes of the proper hepatic artery （PHA） in hepatocellular carcinoma （HCC） with tumor thrombus in the portal stem vein （PSV）. Methods There were 22 cases in HCC group, 26 cases in portal stem vein tumor thrombosis group, 20 cases in normal group were selected as contrast group. Color Doppler ultrasound was used to measure the diameter, systolic maximal velocity （Vmax） and resistant index （RI） of PHA. Results The diameter of the proper hepatic artery （PHA-D） ： normal group 0.33 ± 0.05cm, HCC group 0.44 ± 0.04cm, HCC with partially occlucive PSV tumor thrombus group 0.45 ± 0.04cm, HCC with entirely occlucive PSV tumor thrombus group 0. 61 ± 0.07cm. The Vmax of the proper hepatic artery ： normal group 31.32 ± 9.32cm/s, HCC group 66.76 ± 20.34cm/s, HCC with partially occlucive PSV tumor thrombus group 68.16±21.96cm/s, HCC with entirely occlucive PSV tumor thrombus group 132.65 ± 38.84cm/s. The RI of the proper hepatic artery ： normal group 0.75 ± 0.08, HCC group 0.68 ± 0.13, HCC with partially occlucive PSV tumor thrombus group 0.65 ± 0.11, HCC with entirely occlucive PSV tumor thrombus group 0.55 ± 0.10. There was no significant different in PHA-D, Vmax, RI of partially ocelueive group and those of HCC group （ P 〉 0.05 ）, but there was significant difference in all the other groups （ P 〈 0.01 ）. Conclusion The blood flux obviously compensatorily ascends in HCC with PSV tumor thrombus, RI obviously descends. But it is the occlusive nature of the tumor thrombus and not just the presence of tumor thrombus that is crucial to the hemodynamic change of the proper hepatic artery.