64排螺旋CT诊断肝癌临床价值研究

Value of 64-detector row helical CT on diagnosis for patients with hepatocellular carcinoma

目的研究64排螺旋CT三维重建影像技术在肝癌外科中的临床应用价值。方法对2005年11月至2006年7月,南方医科大学珠江医院行64排螺旋CT三维成像检查34例原发性肝癌临床资料进行总结,并与术中探查结果、手术方式及介入治疗进行对照评价。结果34例原发性肝癌病人64排螺旋CT三维重建成像显示:癌肿肿瘤未侵犯邻近组织、血管者23例,肿瘤压迫邻近血管者9例,动静脉瘘1例,门静脉癌栓1例。3例病人行TACE(经导管肝动脉化疗栓塞术)治疗,其余31例均行手术治疗,与术中探查结果相一致者30例,正确率96.7%。行根治性切除12例,右半肝切除8例,左外叶切除5例,左半肝切除2例,左半肝切除加门静脉癌栓取栓1例,左三叶切除1例,右三叶切除1例,尾状叶切除1例。结论64排螺旋CT三维成像检查可以很好地显示肿瘤的界限、累及范围,特别能精确判断肿瘤与肝脏血管的关系,充分了解肝脏血管变异情况,其结果对病变程度估计及指导外科治疗抉择有重要价值。

Objective To study the Value of 64-detector row helical CT on surgical therapy for patients with hepatocellular carcinoma. Methods 34 patients were examined by 64-detector row helical CT. The results were compared with the intraoperative exploration findings and operative procedures. Results The three-dimensional reconstruction results of 34 cases demonstrated that tissues and blood vessels were not invaded in 23 cases, while portal vein and hepatic vein were invaded by the tumor in 9 cases, and 1 patient was found with arterio-venous fistula, and 1 cases was detected with tumor thrombi in portal vein. 3 cases were performed withinterventional therapy. 30 of other 31 cases were consistent with the intraoperative exploration findings, and the accurate rate was 96. 7%. Radical excision was performed in 12 patients, right hepatectomy in 8 patients,left external lobe resection in 5 patients,left hepatectomy in 2 patients, hepatoma resection and removal of tumor thrombi in 1 patients,left trilobectomy in 1 patients, right trilobectomy in 1 patients, caudate lobe resection in 1 patients. Conclusion The results of three-dimensional reconstruction based on 64-detector row helical CT could definitely demonstrate the tumor limit, especially the relationship between tumor and blood vessels. So the imaging results played an important role in estimating the level of the process and guiding the surgical treatment.