本文選題：肝細(xì)胞肝癌 + 彩色多普勒超聲��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討彩色多普勒超聲檢測肝細(xì)胞肝癌(Hepatocellular Carcinoma,HCC)患者門靜脈、肝動脈血流參數(shù)對HCC的診斷及對影響其預(yù)后的危險因素的評估意義,以及對患者手術(shù)切除后早期復(fù)發(fā)的預(yù)測作用。方法:收集2015年9月-2016年12月于廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院肝膽外科住院并經(jīng)手術(shù)病理證實為HCC的患者共229例,另收集健康體檢者234例作為對照組。彩色多普勒超聲檢查獲取體檢者及HCC患者手術(shù)前及手術(shù)后的門靜脈血流平均流速(V)、門靜脈血流量(Q)、門靜脈內(nèi)徑(D)及肝動脈搏動指數(shù)(PI)、肝動脈阻力指數(shù)(RI),分析這些參數(shù)在HCC患者組與對照組之間的差異、在HCC患者術(shù)前與術(shù)后的差異,及在HCC患者各影響預(yù)后危險因素分組之間的差異,以及術(shù)后早期復(fù)發(fā)組與無復(fù)發(fā)組之間的差異。結(jié)果:1、HCC患者組門靜脈流量、內(nèi)徑明顯大于對照組,肝動脈PI明顯小于對照組,HCC患者術(shù)前門靜脈流速明顯大于術(shù)后,術(shù)前門靜脈內(nèi)徑、肝動脈PI、RI明顯小于術(shù)后(P0.05);2、HCC患者有癌栓組術(shù)前的門靜脈內(nèi)徑、門靜脈流量及肝動脈RI明顯大于無癌栓組,BCLC C期組術(shù)前門靜脈流量、內(nèi)徑及肝動脈RI明顯大于BCLC B期組(P0.05);3、HCC復(fù)發(fā)組術(shù)前肝動脈RI、PI明顯小于無復(fù)發(fā)組(P0.05);PI值的ROC曲線下面積為0.659(P=0.007),RI值的ROC曲線下面積為0.642(P=0.016);PI值為1.05時為最佳臨界值,診斷復(fù)發(fā)的敏感性為68.8%,特異性為66%;RI值為0.645時為最佳臨界值,診斷復(fù)發(fā)的敏感性為68.8%,特異性為58.8%。結(jié)論:多普勒超聲檢測門靜脈、肝動脈血流參數(shù)能對HCC腫瘤的發(fā)生發(fā)展及預(yù)后進(jìn)行監(jiān)測,1、門靜脈內(nèi)徑的增寬、流量的增加及肝動脈PI減低可作為診斷HCC的參考;2、門靜脈內(nèi)徑、流量及肝動脈RI增大能作為反映HCC癌栓的無創(chuàng)評估指標(biāo);3、HCC患者術(shù)前肝動脈PI、RI值越低,術(shù)后復(fù)發(fā)的可能性越大,PI值1.05或RI值0.645可作為預(yù)測HCC術(shù)后早期復(fù)發(fā)的參考值,具有較好的敏感性及特異性。
[Abstract]:Objective: to investigate the value of color Doppler ultrasound in detecting portal vein and hepatic artery blood flow parameters in patients with hepatocellular carcinoma (HCC) and evaluate the prognostic risk factors of HCC and predict the early recurrence after surgical resection. Methods: 229 cases of HCC were collected from September 2015 to December 2016 in Department of Hepatobiliary surgery, affiliated Cancer Hospital of Guangxi Medical University, and 234 healthy persons were selected as control group. Color Doppler ultrasound (CDFI) was used to determine the mean velocity of portal vein blood flow before and after operation, portal vein blood flow, portal vein diameters, hepatic artery pulsatility index (Pi), hepatic artery resistance index (RI) and hepatic artery resistance index (RI) in patients with HCC before and after operation. The difference of parameters between HCC group and control group, The difference between pre-and post-operation in HCC patients, among the groups of prognostic risk factors in HCC patients, and between the early recurrence group and the non-recurrence group after operation. Results the portal vein flow and internal diameter were significantly larger in the patients with HCC than those in the control group, and the Pi of hepatic artery was significantly lower than that in the control group. The flow rate of portal vein before operation was higher than that in the control group, and the diameter of portal vein before operation. The portal vein diameter, portal vein flow and RI of hepatic artery in patients with HCC were significantly lower than those in patients with HCC without tumor thrombus before operation, and the flow of portal vein and RI of hepatic artery were significantly higher than those of BCLC stage without tumor thrombus. The area under the ROC curve of the diameter and RI of the hepatic artery was significantly larger than that of the group with stage B BCLC B and the area under the ROC curve of 0.642P0. 01616PI was the best critical value when the Pi value of the hepatic artery was significantly lower than that of the non recurrence group. The area under the ROC curve was 0. 642P0. 016PI, and the area under the ROC curve was 0. 642P0. 016Pi, which was significantly lower than that of the non recurrence group (P0. 05, P 0. 05, P 0. 05). The sensitivity of diagnosis of recurrence was 68.8 and the specificity was 6645. The sensitivity and specificity of diagnosis of recurrence were 68.8 and 58.8 respectively. Conclusion: the hepatic artery blood flow parameters can be used to monitor the occurrence, development and prognosis of HCC tumor by Doppler ultrasound. The diameter of portal vein is enlarged, the increase of flow rate and the decrease of Pi of hepatic artery can be used as a reference for the diagnosis of HCC and the diameter of portal vein. The increase of flow rate and RI of hepatic artery can be used as a noninvasive index to evaluate HCC thrombus. The lower the RI value of hepatic artery before operation, the greater the possibility of postoperative recurrence. Pi value 1.05 or RI value 0.645 can be used as a reference value for predicting early recurrence after HCC. It has good sensitivity and specificity.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7;R445.1

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本文編號：1908994