超声与DSA对微小肝癌的临床诊断研究分析

Application of Doppler ultrasonography and DSA in the diagnosis of micro-hepatoceUular carcinoma

目的探讨多普勒超声与数字减影血管造影（DSA）在微小肝癌（直径≤1cm癌结节）临床诊断中的应用价值。方法选取2011年9月至2015年9月于本院接受治疗的80例（104个病灶）经病理鉴别诊断证实为原发性微小肝癌或肝癌手术切除术后复发（复发结节直径≤1cm）的患者作为研究对象。对所有患者实施多普勒超声及DSA检测，对比观察两种检测方法的检出率及与病理检查的符合度。结果参与本次研究的80例原发性微小肝癌及术后复发微小肝癌患者经病理证实共计104个微小病灶，实施多普勒超声检测，检出病灶94个，检出率为90．4％；选用DSA检测，共计检出84个病灶，检出率为80．8％，均为单发病灶，直径在0．3～1．0cm之间。微小肝癌或肝癌手术切除术后复发患者造影增强过程中期血液灌注参数也在不断增加，且微小肝癌患者的开始增强、增强峰值、持续增强过程中血流灌注参数增加情况低于其他病变患者，仅峰值强度高于其他病变患者（P〈0．05）。结论对微小肝癌患者或肝癌手术切除术后复发患者的早期诊断宜首选多普勒超声检测方案。

Objective To investigate the application value of Doppler ultrasonography and digital subtraction angiography （DSA） in the diagnosis of micro-hepatocellular carcinoma （diameter of nodules ≤ 1 cm）. Methods 80 patients （104 lesions） with primary micro-hepatocellular carcinoma through pathological and differential diagnosis or recurrence after liver cancer resection （diameter of recurrent nodules ≤ 1 cm） treated in our hospital from Sep 2011 to Sep 2015 were selected as the research object. All patients underwent Doppler ultrasonography and DSA detection. Compared the detection rate of two kinds of detection methods and the conformity of pathological examination. Results 80 patients with primary or postoperative recurrent micro- hepatocellular carcinoma in this study had 104 pathologically confirmed micro lesions. Doppler ultrasonography detected 94 lesions, the detection rate was 90.4%; DSA detected 84 lesions, the detection rate was 80.8%, all single lesion, the diameter was from 0.3 to 1.0 cm. Blood perfusion parameters constantly increased during the process of contrast enhancement in patients with micro-hepatocellular carcinoma or recurrence after liver cancer resection, and the increased degree of blood perfusion parameters （the beginning of enhancement, enhancement peak, constant enhancement） of patients with micro-hepatocellular carcinoma were lower than those of patients with other diseases, peak intensity was higher than that of patients with other diseases （P〈0.05）. Conclusion Doppler ultrasonography should be the first choice in the early diagnosis of patients with micro-hepatocellular carcinoma or recurrence after liver cancer resection.