原发性肝癌不同参数数字减影血管造影的临床研究

The Clinical Study of Different Parameters DSA on Primay Hepatic Carcinoma

目的：研究原发性肝癌（PHC）经肝总动脉造影（RA）与长时程低流率造影（LTLRA）的病灶血供表现，及病灶检出的敏感性，并探讨其质量控制措施。方法：选择经临床诊断的PHC患者220例，根据造影参数的不同分为RA、LTLRA两组。在DSA设备下行肝总动脉不同参数造影（RA与LTLRA），对造影图像进行分析评价，对造影表现、检出病灶进行统计学处理。结果：检查220例病例，曝光采集896个序列，图像质量优726个序列，占81％；造影血供表现为：肝总动脉增粗、肝动脉受侵、抱球征、肿瘤血管、肿瘤染色、肝动脉一门静脉瘘、肝动脉一肝静脉瘘等，其中以肿瘤染色和肿瘤血管出现率最高，均为100％；不同大小的病灶血供表现各不相同；病灶检出方面，LTLRA组较RA组检出病灶多129个，检出率提高18．67％，两组比较，有显著性差异（P〈0．05），≤1cm病灶组有极显著性差异（P〈0．01）。结论：肝总动脉不同参数造影（RA与LTLRA）对PHC肿瘤血供的显示、病灶的检出有着重要的意义；病灶由小到大生长过程中伴随着血供的不断变化，LTLRA可明显提高病灶检出率，特别是对于≤1cm的病灶；LTLRA可作为肝癌诊断及治疗前的常规造影。

Objective： To discuss the lesion＇s blood supply of primay hepatic carcinoma（PHC） by hepatic artery routine angiography （RA） and long time low rate angiography （LTLRA） , and to approach the sensititivity of lesion, s detection and measures of quality control（QC）. Methods： 220 cases of PHC diagnosed by clinic were classified RA and LTLRA groups according to the difference of DSA parameters. All patients were performed RA and LTLRA under the control of DSA. The DSA images were analyzed, and data were dealed with statistical method. Resuits： The study obtained 220 cases and 896 exposure sequences, and the quality of image was excellent in 726 sequences （ 81% ）. On DSA images, the PHC lesion＇s sign showed dilation of liver artery or its branches, invasion of liver artery, sign of grasping sphere, tumor vessels and tumor colouration, and fistula of liver atery- portal vein or liver atery - liver vein. The detecting rates of the sign of tumor vessels and tumor colouration were the highest（ 100% ）. The sign of blood supply was different in various size of lesions. The method of LTLRA detected more 129 lesions as many as RA, and increased 18.67% in detecting rate compared to RA. The statistical analysis showed that there was a significant difference in the sensitivity of lesion, s detection between RA and LTLRA（ P 〈 0.05 ） , especially as to the lesion with diameter 〈 1 cm （ P 〈 0.01 ）. Conclusions： The different parameters angiography（ RA and LTLRA） of hepatic artery had a great significance in detecting PHC lesions and displaying the lesion＇s blood supply. The method of LTLRA could remarkably increase the lesion, s detecting rate and especially presented more sensitive to the lesions with poor blood supply and small size. LTLRA of hepatic artery should become the routine examination of PHC.