彩超引导下门静脉癌栓细针穿刺活检术在门静脉癌栓的诊断和疗效评价中的价值(附25例报告)

Colored Doppler ultrasound guided fine needle aspriation biopsy of portal vein thrombosis: value in diagnosis and assessment of therapeutic efficacy for portal vien thrombosis

目的探讨彩超引导下门静脉癌栓穿刺活检术在门静脉癌栓的诊断和疗效评价中的价值。方法２５例患者接受肝动脉栓塞化疗和门静脉化疗，在治疗前后分别行彩色超声多普勒引导下门静脉癌栓细针自动活检术，对活检标本进行总结分析。结果（１）穿刺取材成功率为１００％，无明显并发症，均可作出满意的病理诊断。（２）治疗前癌栓内均有血流频谱，活检病理为增殖型，细胞呈条柱状排列。治疗后３周，４例（１６．０％）患者癌栓内多普勒血流频谱消失，相应活检病理证实癌栓坏死，其中２例获二期切除；２１例（８４．０％）治疗后癌栓无明显改变。结论彩色多普勒超声引导下门静脉癌栓穿刺活检安全准确，取材迅速可靠，对门静脉癌栓的诊断和指导治疗均有重要意义。

Objective To investigate the value of colored Doppler ultrasound guided fine needle aspiration(FNA) biopsy of portal vien thrombosis(PVT) in diagnosis and assessment of therapeutic efficacy for PVT. Methods Cytologic findings from 25 portal vien thrombosis patients who underwent FNA were reviewed before and after hepatic arterial chemo embolization(HAE) and portal vien chemotherapy. Results 1. Biopsy specimens sufficient for histologic analysis were obtained in all cases (100%). No complications resulted from this procedure. 2. The blood flow within the portal vien with thrombosis could be detected by colored Doppler systems in 25 cases before the patients accepted the treatment. The proliferation and a trabecular cellular arrangement presented in all the cell blocks. Of the 25 cases, 4(16.0%) demonstrated necrosis of the tumor thrombi and the disappearance of blood flow within portal vein thrombi three weeks after the treatment. Among the 4,2 were followed up clinically and underwent second stage resection. 21(84.0%) cases had no significant change in portal vein thrombosis pathologically and ultrasonically after the treatment. Conclusion Colored Doppler ultrasound guided FNA biopsy of portal vein thrombi is a safe, accurate, sampling reliable biopsy technique.