PHC不同参数数字减影血管造影的临床价值分析

The clinical value of different parameters of DSA on primaryhepatic carcinoma

目的分析PHC经肝总动脉RA与LTLRA的临床价值。方法选择经临床诊断的PHC患者300例(男性258例,女性42例,平均年龄41岁),根据造影参数的不同分为RA、LTLRA两组。采集一般临床资料并完善术前检查;在DSA设备下行肝总动脉不同参数造影(RA与LTLRA),对造影表现、检出病灶进行统计学处理。结果检查300例病例,曝光采集1225个序列,其造影图像血供表现为:变异肝动脉、侧枝供血、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-门静脉瘘、肝动脉-肝静脉瘘、血管湖等。造影表现有极显著性差异(P<0.01)。造影表现显现率由高到低前四位的是肿瘤染色、肿瘤血管、抱球征、肝动脉受侵,RA组共1865处,LTLRA组2071处,两组相比,具有显著性差异(P<0.05)。RA组共检出病灶766个,直径≤1cm的202个;LTLRA组检出病灶942个,直径≤1cm的358个;病灶检出方面,LTLRA组较RA组检出病灶多176个,检出率提高18.68%,两组相比,有显著性差异(P<0.05),≤1cm病灶组有极显著性差异(P<0.01)。而且不同大小的病灶血供特点各不相同。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。PHC病灶由小到大的生长过程中,伴随着血供不断的复杂的变化;LTLRA可明显提高病灶检出率,特别是对血供不丰富及较小病灶的检出更敏感,LTLRA可作为肝癌诊断及介入治疗的常规造影。

Objective To discuss the clinical value of different parameters of DSA in diagnosis of primary hepatic carcinoma（PHC） .Methods Three hundred cases of PHC diagnosed by clinic were divided into RA and LTLRA groups according to the different parameters of DSA.All patients were performed RA and LTLRA under the control of DSA.The DSA images were analyzed,and data were dealed with statistical method.Results The study obtained 300 cases and 1225 exposure sequences.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 hepatic artery-portal vein or hepatic artery-hepatic 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 176 lesions as many as RA,and increased 18.68%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 diameter1cm（P〈0.01） .Conclusion The different parameters angiography（RA and LTLRA） of hepatic artery have 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.