不同角度数字减影血管造影在肝肿瘤介入治疗中的应用价值

Evaluation of Different Angle DSA in Interventional Therapy of Liver Neoplasm

目的探讨不同角度数字减影血管造影(DSA)技术在肝肿瘤经动脉栓塞术中的应用价值。方法采用C型臂X光机系统,52例原发性肝癌患者每一病例均在介入化疗栓塞前后行肝固有动脉常规及不同角度DSA检查,比较两种方法对肝内病灶个数及肿瘤供血动脉的敏感性。结果常规DSA显示病灶个数为62个,有21例患者肝亚段动脉因相互重叠不能被独立分辨,18例因多支动脉分支与肿瘤位置重叠而不能确认肿瘤供血来源。而不同角度方法显示病灶个数66个,发现4个常规DSA漏诊的小病灶,在50例中清晰显示了肝亚段动脉的结构,复杂的肿瘤供血动脉及其走行,两种方法比较χ2=12.64,P<0.05。结论不同角度DSA能够多方位清晰地显示迂曲走行的动脉和重叠隐匿的较小的肿瘤病灶,显著提高小病灶检出率,提高超选择性插管的成功率和降低肝脏肿瘤的漏诊率,是一种重要的补充检查手段,有着重要的临床意义。

Objective To discuss the application value of different angle DSA technique in the interventional management of liver neoplasm. Methods With PHILIPS Allrua DSA unit, both conventional and different angle DSA angiography of the proper hepatic artery were performed in 52 patients with liver neoplasm who were divided into control group and different angle DSA group before and after the interventional management. The detection of the lesion＇ s number and the tumor-feeding artery was compared between images of two groups. Results 62 focuses of the liver neoplasm were displayed in control group, the whole course of the tumor-feeding artery could not be clearly displayed due to excessive tortuosity of the vessels in 18 patients, sub-segmental branches of hepatic artery could not be clearly resolved due to interlap in 21 patients; 66 focuses of the liver neoplasm were displayed in different angle DSA group, sub-segmental branches of hepatic artery could be demonstrated satisfactorily in 50 patients. Different angle DSA revealed 4 small lesions, which were missed by conventional angiogaphy. The tumor arteries and lesions were observed and analyzed with X^2 test, （X^2 = 12.64, P 〈0.05）. Conclusion The different angle DSA can well display tumor-feeding arteries from different angles and detect small overlapped lesions which were overlapped on conventional images. As an important supplementary means, different angle DSA is of great help to improve the successful rate of super-selective catheterization.