多层螺旋CT血管造影在原发性肝癌肝动脉-门静脉瘘诊断中的应用

Application of multi-slice spiral CT angiography in diagnosing hepatic artery-portal vein fistula in primary hepatic carcinoma patients

目的分析多层螺旋CT血管造影(MSCTA)诊断原发性肝癌(PHC)病人肝动脉-门静脉瘘(HAPVF)的价值及影响HAPVF发生危险因素。方法选择无锡市第五人民医院2017年9月至2019年4月收治的129例PHC病人作为研究对象,根据是否并发HAPVF分为HAPVF组和非HAPVF组。统计PHC病人HAPVF的发生情况,并以DSA检查结果为“金标准”,分析MSCTA评估PHC病人HAPVF的准确性,此外分析与HAPVF发生相关的危险因素。结果129例PHC病人经DSA检查检查共发现40例HAPVF(占31.0%),其中周围型17例(占42.5%),中央型23例(占57.5%);经MSCTA检查37例HAPVF病人获得了正确分型诊断,诊断准确率为92.5%(37/40),与DSA检查结果表现出良好的一致性(Kappa=0.85);单因素分析初步筛选出了4个(肝功能Child-Pugh分级、肿瘤数目、肿瘤最大径、合并肝硬化)与PHC病人并发HAPVF有关的因素;多因素logistic回归分析显示肝功能Child-Pugh分级(OR=10.341,P<0.001)、肿瘤最大径(OR=3.385,P=0.037)、合并肝硬化(OR=4.440,P=0.028)为PHC病人并发HAPVF的危险因素。结论PHC病人出现HAPVF的发生率高,MACTA可发现HAPVF并对其分型做出正确评估,能用于指导治疗。此外,肝功能Child-Pugh分级、肿瘤最大径、合并肝硬化等均为影响PHC病人并发HAPVF的危险因素。

Objective To analyze the value of multi-slice spiral CT angiography(MSCTA)in diagnosing hepatic artery portal venous fistula(HAPVF)in primary hepatic carcinoma(PHC)patients and the risk factors influencing HAPVF.Methods A total of 129 PHC patients admitted to Wuxi Fifth People's Hospital from September 2017 to April 2019 were selected as the study objects,and were divided into HAPVF group and non-HAPVF group according to whether they were complicated with HAPVF or not.The occurrence of HAPVF in PHC patients was statistically analyzed,and the DSA examination results were taken as the"gold standard"to analyze the accuracy of MSCTA in evaluating HAPVF in PHC patients,and the risk factors related to the occurrence of HAPVF were also analyzed.Results A total of 40 cases of HAPVF(31.0%)were found in 129 PHC patients by DSA examination,including 17 cases of peripheral type(42.5%)and 23 cases of central type(57.5%);After MSCTA examination,37 HAPVF patients obtained the correct classification diagnosis,and the diagnostic accuracy was 92.5%(37/40),which showed good consistency with DSA examination results(Kappa value=0.85);Single factor analysis initially screened out 4 factors(child-pugh grading of liver function,number of tumors,maximum tumor diameter,combined with cirrhosis)related to HAPVF in PHC patients;Multivariate logistic regression analysis showed that child-pugh grading of liver function(OR=10.341,P<0.001),maximum tumor diameter(OR=3.385,P=0.037),and combined cirrhosis(OR=4.440,P=0.028)were risk factors for HAPVF in PHC patients.Conclusions The incidence of HAPVF in PHC patients is high,and MACTA can discover HAPVF and make a correct assessment of its classification for therapeutic guidance.In addition,Child-Pugh grading of liver function,maximum tumor size and combined cirrhosis are all risk factors affecting the complication of HAPVF in PHC patients.