DynaCT在原发性肝癌介入治疗的应用价值

Application value of DynaCT in patients with hepatic carcinoma undergoing transcatheter arterial chemoembolization

目的:评价C臂计算机断层扫描(Dyna computed tomography,Dyna CT)技术在肝癌介入治疗中的应用价值及疗效,为临床合理应用Dyna CT提供依据.方法:回顾性分析89例原发性肝癌介入患者,分为Dyna CT组与常规数字减影血管造影(digtal subtraction angiography,DSA)组,DynaC T组46例,常规DSA组43例,DynaC T组为二维常规DSA联合增强Dyna CT检查.对两组的手术操作时间、X线辐射量及造影剂用量进行对比分析;同时对Dyna CT检出病灶数量和明确血管走行的能力与常规DSA及螺旋CT进行对比,并随访两组患者,统计总生存期进行对比分析.结果:与常规DSA组相比,Dyna CT组缩短了手术时间(P<0.05);两组间X线辐射量及造影剂用量间差异无统计学意义,说明术中加做Dyna CT检查并未增加X线辐射量和造影剂用量.Dyna CT组共检测病灶92个(46例患者),在直径<10 m m及10-20 m m直径的小肝癌中,Dyna CT的诊断敏感率明显优于螺旋CT(P<0.001);直径>20 mm肝癌中三种检查方法均能明确诊断,不具有统计学差异.Dyna CT组内46例患者中共有11例行常规DSA后发现肿瘤供血动脉严重前后重叠,不能分辨肿瘤具体供血动脉,行增强D y n a C T后,其中9例肿瘤供血动脉分支及走行显影清晰,超选择插管后诊断明确.二者差异有统计学意义.Dyna CT组总生存期为17.3 mo±1.1 mo,常规DSA组总生存期为12.6 mo±0.9 mo,经Log-rank检验,P=0.003.结论:常规DSA基础上应用Dyna CT在原发性肝癌介入化疗栓塞中具有重要的临床应用价值,提供更多诊断治疗信息,改善患者预后.

AIM： To evaluate the application value of Dyna computed tomography（Dyna CT） technology in hepatic carcinoma patients undergoing transcatheter arterial chemoembolization（TACE） and to provide evidence for clinical utilization of Dyna CT. METHODS： Eighty-nine patients with primary liver cancer were retrospectively analyzed, and they were divided into either a Dyna CT group（46 cases） or a conventional digital subtraction angiography（DSA） group（43 cases）. Patients in the DynaC T group underwent two-dimensional conventional DSA combined with Dyna CT, and the conventional DSA group underwent DSA only. Operative time, X-ray radiation and dosage of contrast agent were analyzed in two groups. The number of lesions detected and the ability to detect blood vessels were compared between the two groups. All patients were followed to analyze overall survival.RESULTS： Compared with the conventional DSA group, the DynaC T group has significantly shortened operative time（P〈0.05）. There was no statistical significant difference in X-ray radiation and dosage of contrast medium between the two groups. Dyna CT detected a total of 92 lesions（in 46 patients）. Dyna CT was superior to conventional CT and MDCT in the detection of lesions with a diameter 10 mm or between 10 and 20 mm（P〈0.001）, although there was no significant difference in the detection of lesions with a diameter 20 mm. Eleven cases in the Dyna CT group manifested no clear tumor feeding artery during conventional DSA, of which 9 cases had clearly indicated blood supplying artery branches by Dyna CT. Overall survival of the Dyna CT group was 17.3 mo ± 1.1 mo, which was significantly longer than that of the conventional DSA group（12.6 mo ± 0.9 mo; Log-rank, P = 0.003）. CONCLUSION： Utilization of Dyna CT on the basis of conventional DSA in TACE for primary liver cancer has important clinical value, providing more diagnosis and treatment information that can help improve the prognosis of patients.