本文選題：原發(fā)性肝癌 + 多層螺旋CT血管成像　； 參考：《中華腫瘤防治雜志》2017年11期

【摘要】：目的原發(fā)性肝癌(primary liver cancer,PLC)是我國常見的惡性腫瘤之一,治療尤其是介入治療前,需詳細(xì)了解肝臟及肝臟腫瘤的血管準(zhǔn)確解剖。多層螺旋CT血管造影(multislice spiral CT angiography,MSCTA)具有掃描速度快,覆蓋范圍廣,后處理技術(shù)成熟等優(yōu)勢(shì),本研究旨在探討MSCTA在PLC患者肝動(dòng)脈-門靜脈瘺(hepatic artery-portal vein fistula,HAPVF)及肝外供血?jiǎng)用}術(shù)前評(píng)估中的臨床應(yīng)用價(jià)值。方法回顧性分析2014-10-01-2015-10-01山東大學(xué)附屬山東省腫瘤醫(yī)院介入科收治的90例PLC患者M(jìn)SCTA和數(shù)字減影血管造影(digital subtraction angiography,DSA)臨床資料,評(píng)價(jià)HAPVF和肝動(dòng)脈-肝靜脈瘺(hepatic artery-hepatic vein fistula,HAHVF)發(fā)生率及其與腫瘤大小、部位和肝硬變程度的關(guān)系;肝外供血?jiǎng)用}與毗鄰腫瘤的關(guān)系。以DSA結(jié)果為金標(biāo)準(zhǔn),分析MSCTA評(píng)估PLC血管異常的準(zhǔn)確性。結(jié)果 90例PLC患者中,共發(fā)現(xiàn)HAPVF 48例,發(fā)生率為53.3%,其中A組0例,B組5例(10.4%),C組17例(35.4%),D組26例(54.2%);中心型28例(58.3%),周圍型20例(41.7%);Child-Pugh A級(jí)34例(70.8%),Child-Pugh B級(jí)12例(25%),Child-Pugh C級(jí)2例(4.2%)。HAHVF 4例,發(fā)生率為4.4%。二元Logistics回歸分析顯示,腫瘤大小及肝硬變程度是HAPVF的獨(dú)立危險(xiǎn)因素,P0.05。MSCTA共檢出HAPVF 45例,中央型28例,準(zhǔn)確率為100.0%(28/28);周圍型17例,準(zhǔn)確率85.0%(17/20);總體準(zhǔn)確率為93.8%(45/48),與DSA結(jié)果進(jìn)行比較,差異無統(tǒng)計(jì)學(xué)意義,χ~2=3.097,P0.05。19例患者存在24條肝外供血?jiǎng)用},均發(fā)生于C組和D組,周圍型和中心型分別為87.5%和12.5%,MSCTA發(fā)現(xiàn)22條,兩者比較差異無統(tǒng)計(jì)學(xué)意義,χ~2=2.087,P0.05。結(jié)論 MSCTA技術(shù)可準(zhǔn)確顯示HAPVF及肝外供血?jiǎng)用},腫瘤大小及肝硬化分級(jí)是肝動(dòng)-靜脈瘺的獨(dú)立危險(xiǎn)因素。肝外供血?jiǎng)用}多發(fā)生于塊狀型、巨塊型且位于多肝臟邊緣區(qū)域的肝癌。
[Abstract]:Objective (primary liver cancer is one of the most common malignant tumors in China. Multislice spiral CT angiography (multislice spiral) has the advantages of fast scanning speed, wide coverage, mature post-processing technology, and so on. The purpose of this study was to evaluate the clinical value of MSCTA in preoperative evaluation of hepatic arterial-portal vein fistula (hepatic artery-portal vein fistula) and extrahepatic feeding artery. Methods the clinical data of 90 patients admitted to the Department of Interventional Medicine of Shandong Cancer Hospital affiliated to Shandong University from January 2014 to January 2015-01 were retrospectively analyzed. The clinical data of (digital subtraction and hepatic artery-hepatic vein arterio-hepatic venous fistula (HHVF) were evaluated. The relationship between the location and the degree of cirrhosis and the relationship between the extrahepatic blood supply artery and adjacent tumors. Using DSA results as gold standard, the accuracy of MSCTA in assessing the vascular abnormalities of PLC was analyzed. Results among 90 PLC patients, 48 cases (53.3%) were found with HAPVF, including 5 cases (10.4%) in group A, 17 cases (35.4%) in group C, 26 cases (54.2%) in group D, 28 cases (58.3%) in central type, 20 cases (41.7%) in peripheral type, 34 cases (70.8%) in Child-Pugh A grade, 12 cases (25%) in Child-Pugh B grade, 2 cases (4.2%) in Child-Pugh C grade and 4 cases in HAHVF group. Binary Logistics regression analysis showed that tumor size and degree of cirrhosis were independent risk factors of HAPVF (P0.05.MSCTA) in 45 cases, central type in 28 cases, peripheral type in 17 cases, accuracy rate in 85.0% (17 / 20), total accuracy rate was 93.8% (45 / 48). There were 24 extrahepatic supply arteries in group C and D, the peripheral type and central type were 87.5% and 12.5%, respectively. There was no significant difference between them (蠂 2 / 22.087P 0.05). Conclusion MSCTA is an independent risk factor for hepatic arteriovenous fistula. Most of the extrahepatic blood supply arteries occur in massive, massive liver cancer, which are located in the marginal region of multiple livers.
【作者單位】： 山東大學(xué)附屬山東省腫瘤醫(yī)院影像科;山東大學(xué)附屬山東省腫瘤醫(yī)院放療科;山東大學(xué)附屬山東省腫瘤醫(yī)院外七科;山東大學(xué)附屬山東省腫瘤醫(yī)院科教部;
【基金】：山東省醫(yī)學(xué)科學(xué)院科技計(jì)劃面上項(xiàng)目(2014-10,2014-15)
【分類號(hào)】：R730.44;R735.7

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