【摘要】：目的探尋320排容積CT上腹部一站式檢查在肝癌經(jīng)動(dòng)脈插管化療栓塞（transcatheter arterial chemoembolization，TACE)治療中的臨床應(yīng)用價(jià)值。 方法收集30例肝癌患者TACE術(shù)前行320排CT上腹部灌注掃描病例，分析全肝灌注情況，與TACE術(shù)中數(shù)字減影血管造影（digitalsubtraction angiography，DSA）圖像對(duì)比了解其血管成像能力，術(shù)后隨訪病灶灌注情況并與術(shù)前對(duì)比分析。對(duì)320排灌注容積掃描行輻射劑量分析。 結(jié)果TACE術(shù)前肝癌組織肝動(dòng)脈灌注量（hepatic arterialperfusion,HAP）、門靜脈灌注量(portal vein perfusion,PVP)及肝動(dòng)脈灌注指數(shù)（hepatic arterial perfusion index,HAPI)與非癌組織相比，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；術(shù)后腫瘤壞死組織無血流灌注；腫瘤活性組織的HAP、PVP較術(shù)前升高，HAPI則下降，較術(shù)后非癌組織其HAP及HAPI升高，而PVP則明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。30次掃描中均能獲得滿意上腹部CT血管成像（computer tomographyangiography,CTA)圖像；對(duì)1～4級(jí)肝動(dòng)脈CTA與DSA對(duì)比顯示，差異無統(tǒng)計(jì)學(xué)意義（P0.05）,5級(jí)及以上肝動(dòng)脈CTA與DSA比較，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。劑量對(duì)比發(fā)現(xiàn)低參數(shù)（100kV、100mA）灌注掃描較常規(guī)上腹部增強(qiáng)掃描輻射劑量低，稍高參數(shù)灌注掃描方案（100kV、200mA）輻射劑量僅輕度增高。 結(jié)論320排容積CT上腹部一站式檢查能很好的顯示全肝灌注情況，，尤其是肝癌組織的異常灌注情況及術(shù)后活性灶，血管成像能夠從三維角度顯示肝動(dòng)脈及腫瘤滋養(yǎng)動(dòng)脈，對(duì)TACE術(shù)前評(píng)估、術(shù)中操作及術(shù)后隨訪都具有重要的指導(dǎo)意義。
[Abstract]:Objective to explore the clinical value of 320 row volume CT in the treatment of hepatocellular carcinoma (HCC) by arterial catheterization and chemoembolization (transcatheter arterial chemoembolization,TACE). Methods Thirty patients with hepatocellular carcinoma underwent 320 rows of CT upper abdominal perfusion scan before TACE. The total hepatic perfusion was analyzed and compared with TACE intraoperative digital subtraction angiography (digitalsubtraction angiography,DSA). Focus perfusion was followed up after operation and compared with that before operation. Radiation dose analysis was performed on 320 row perfusion volume scanning. Results the hepatic artery perfusion volume (hepatic arterialperfusion,HAP), portal vein perfusion volume (portal vein perfusion,PVP) and hepatic artery perfusion index (hepatic arterial perfusion index,HAPI) before TACE were significantly different from those in non-cancerous tissues (P0.05). The HAP,PVP of tumor active tissue was lower than that of preoperation, HAP and HAPI were higher than that of non-cancerous tissue after operation, but PVP was significantly lower. The difference was statistically significant (P0.05) .30 times of CT angiography (computer tomographyangiography,CTA) images of upper abdomen could be obtained. There was no significant difference in hepatic artery CTA and DSA between grade 1 and grade 4 (P0.05). CTA of grade 5 and above was significantly higher than that of DSA (P0.05). The dose contrast showed that the dose of low parameter perfusion scan (100kV / 100mA) was lower than that of conventional epigastric enhanced scan, and the radiation dose of a slightly higher perfusion scan scheme (100kV / 200mA) was only slightly higher than that of conventional epigastric enhanced scan. Conclusion One-stop CT can show the whole liver perfusion, especially the abnormal perfusion of liver cancer tissue and the postoperative active focus. Angiography can display the hepatic artery and tumor trophoblastic artery in three dimensional angle. It has important guiding significance for preoperative evaluation, intraoperative operation and postoperative follow-up of TACE.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R735.7;R730.55

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