彩色多普勒超声对门静脉癌栓肝动脉血流动力学变化的研究

A study of the hepatic artery blood flow in portal stem vein tumor thrombus with color Doppler ultrasound

目的探讨肝细胞癌合并门静脉主干癌栓时的肝动脉血流动力学变化。方法将60例肝细胞癌合并门静脉主干癌栓患者根据癌栓对门静脉主干的阻塞程度分为部分性阻塞组和完全性阻塞组，每组30例，应用彩色多普勒超声测量肝固有动脉内径（PHA-D）、收缩期最大血流速度（Vmax）以及阻力指数（RI），并与80例肝细胞癌无门静脉癌栓患者（肝癌组）和20例健康体检者（对照组）作对比。结果对照组、肝癌组、部分性阻塞组、完全性阻塞组PHA-D分别为（O．33±0．05）、（O．44±0．04）、（0．45±0．04）、（0．61±0．07）cm，Vmax分别为（31．32±9．31）、（66．76±20．34）、（68．16±21．96）、（132．65±38．84）cm／s，R1分别为0．75±0．08、0．68±0．13、0．65±0．11、0．55±0．10。肝癌组、部分性阻塞组、完全性阻塞组PHA．D、V—RI与对照组比较差异均有统计学意义（P〈0．01或〈0．05）；完全性阻塞组PHA-D、Vmax、RI与肝癌组和部分性阻塞组比较差异均有统计学意义（P〈0．01）。结论肝细胞癌合并门静脉主干癌栓时，肝动脉血流量明显代偿性增加，RI明显减低，但肝动脉血流动力学的改变主要取决于癌栓对门静脉主干的阻塞程度，而并非取决于门静脉癌栓的有无。

Objective To investigate the hemodynamic changes of the proper hepatic artery （PHA） in hepatocellular carcinoma （HCC） and portal stem vein tumor thrombus. Methods Sixty HCC and portal stem vein tumor thrombus patients were divided into partial occlusion group and completely occlusion group with 30 patients each. Eighty HCC patients without portal stem vein tumor thrombus were in HCC group and 20 health cases were in control group. Color Doppler ultrasound was used to measure the diameter of PHA （PHA-D）, systolic maximal velocity （Vmax） and resistant index （RI） of PHA. Results PHA-D in control group,HCC group,partial occlusion group and completely occlusion group was （0.33 ± 0.05）, （0.44 ± 0.04）, （0.45 ± 0.04）, （0.61 ± 0.07） cm,Vmax was （31.32 ± 9.31）, （66.76 ± 20.34）, （68.16 ± 21.96）, （ 132.65 ± 38.84） cm/s, RI was 0.75 ± 0.08,0.68 ±0. 13,0.65 ± 0.11,0.55 ± 0.10, respectively. The levels of PHA-D, Vm and RI in HCC group, partial occlusion group and completely occlusion group had significant difference compared with those in control group （P 〈 0.01 or 〈 0.05）. The levels of PHA-D, Vmax and RI in completely occlusion group had significant difference compared with those in HCC group, partial occlusion group（P 〈 0.01 ）. Conclusions The blood flux obviously ascends compensatorily in HCC with portal stem vein tumor thrombus, RI obviously descends. But it is the occlusive nature of the tumor thrombus that is crucial to the hemodynamic change of the proper hepatic artery.