应用多普勒超声对肝转移癌及肝硬化患者的血流动力学研究

Study on hepatic hemodynamics in patients with liver metastases and cirrhosis by using Doppler ultrasound

目的： 应用多普勒超声（Ｄ－ ＵＳ） 测定多普勒血流灌注指数（ＤＰＩ）， 门脉充血指数（ＰＣＩ）和阻力比（ＲＲ）等血流参数在肝转移癌和肝硬化时的变化， 用以评价这些血流参数对转移癌和肝硬化的诊断价值。材料与方法： １５ 例肝硬化，１５ 例肝转移癌和１８ 例对照组在禁食１２ 小时后， 分别测其肝总动脉（ＣＨＡ）， 肠系膜上动脉（ＳＭＡ）和门静脉（ＰＶ） 的有关血流参数，并计算ＤＰＩ， ＰＣＩ， ＲＲ等。结果： ①肝转移癌组的ＤＰＩ显著高于肝硬化组和对照组（Ｐ＜０－０１）。②肝转移癌的ＲＲ显著高于对照组和肝硬化组（Ｐ＜ ０－０５， Ｐ＜０－０１）。肝硬化组的ＲＲ又低于正常对照组（Ｐ＜ ０－０５）。③肝硬化组的ＰＣＩ显著高于对照组和转移癌组（Ｐ＜０－０１）。④肝硬化组的肝总血流量高于对照组（Ｐ＜０－０１）， 而其它组之间差异不显著。结论： 肝硬化与肝转移癌患者的肝动脉、ＳＭＡ和ＰＶ的血流量及阻力变化各异， 通过测定ＤＰＩ， ＰＣＩ， ＲＲ等血流参数， 对它们有重要的诊断和鉴别诊断价值。

Objective:To assess the value of the Doppler perfusion index(DPI:the ratio of hepatic arterial to total liver blood flow),portal vein congestive index(PCI:the ratio of the cross sectional area of the vessel to time averaged velocity of blood flow in the vessel)and resistive ratio(RR:the ratio of the resistive index of the superior mesenteric artery to that of the hepatic artery)measured with Doppler ultrasound(D-US)in the differentiation of the patients with cirrhosis and those with hepatic metastases.materials and methods:In 15 patients with cirrhosis,15 with metastases and 18 control subjects,the DPI,PCI and RR were measured by using D-US after 12 hours of fasting.Results:①The DPI of the metastases group was significantly raised compared with that of the controls and cirrhosis group(p<0 01).②The RR of the metastases group was higher than that of the control and cirrhotic groups(P<0.05,P<0 01),and the RR of the cirrhotic group was lower than that of controls(P<0 05).③The PCI of the cirrhotic group was significantly increased compared with that of the control and metastases groups(P<0 01).④The total liver blood flow(TLBF)of the cirrhotic group was significantly raised compared with that of controls,but there were no significant difference between the other groups.Conclusion:The results suggest that the D-US parameters such as DPI,PCI and RR can be used to evaluate of demonstrate the difference in the hepatic perfusion between patients with cirrhosis and those with hepatic metastases and therefore are of great value in the differential diagnosis of those patients.