Dyna CT在肝细胞肝癌行肝动脉化疗栓塞的应用价值

Application of Dyna CT in transhepatic arterial chemotherapy and embolization in patients with hepatocellular carcinoma

目的研究Dyna CT(C-臂CT)在肝细胞肝癌(HCC)行肝动脉化疗栓塞(TACE)中的应用价值。方法 138例行TACE的HCC患者中,69例(A组)行Dyna CT和传统DSA,69例(B组)仅行DSA。观察腹腔干(CA)、肠系膜上动脉(SMA)及其分支的走形以及肿瘤供血动脉、肿瘤大小、数目,比较两组手术时间及患者2年总生存率。结果 A组中,Dyna CT显示60例肝动脉起源于CA,9例肝右动脉起源于SMA且肝左动脉起源于肝总动脉。Dyna CT共检测出258个肿瘤,多于传统DSA的178个(P<0.05)。A组手术时间短于B组[(43.6±15.8)min vs.(55.3±20.9)min],且2年总生存率高于B组(69.5%vs.53.6%)(P<0.05)。结论 Dyna CT在显示肿瘤数目、肝血管走行和分支方面优于传统DSA。Dyna CT可为TACE提供更优化的操作引导,使介入术中的精准超选更简单,提高TACE治疗质量。

Objective To explore the application of Dyna CT（C-arm CT）in transhepatic arterial chemotherapy and embolization（TACE）in the patients with hepatocellular carcinoma（HCC）.Methods A total of 138 HCC patients underwent TACE was equally divided into two groups of A[examined with Dyna CT and routine digital subtraction angiography（DSA）]and B（examined with DSA alone）.The celiac artery（CA）and superior mesenteric artery（SMA）shape and branch anatomy were observed,as well as number of tumors and arteries feeding the lesions.Operation time and overall2-year survival rate were compared between two groups.Results In group A,Dyna CT showed the hepatic artery originated from CA in 60 cases,of which the right hepatic artery originated from the SMA and the left hepatic artery originated from common hepatic artery in 9cases.A total of 258 lesions was found by Dyna CT,which was more than 178 lesions by routine DSA（P〈0.05）.Compared with group B,the operation time was shorter[（43.6±15.8）minutes vs.（55.3±20.9）minutes]and 2-year overall survival rate was higher（69.5% vs.53.6%）in group A（P〈0.05）.Conclusion Dyna CT has substantial advantages over routine DSA in demonstrating the shape and branches of target hepatic vessels and the number of tumors.Dyna CT provides important guidance for TACE,which simplifies selective catheterization and improves therapeutic quality of TACE.