肝癌伴肝动脉-门静脉瘘的螺旋CT和数字减影血管造影类型及介入治疗

目的:探讨肝癌伴肝动脉-门静脉瘘(APF)的发生机制,研究螺旋CT(HCT)和数字减影血管造影(DSA)对其的分型及介入治疗中的问题.方法:48例肝癌伴APF的患者均行CT增强扫描和DSA检查.根据HCT和DSA表现,APF可分为周围型、肝段型和中央型.结果:HCT对48例患者的APF分型为:周围型14例(14/48)、肝段型15例(15/48)、中央型19例(19/48).DSA对患者的APF分型为:周围型13例(13/48)、肝段型16例(16/48)、中央型19例(19/48).HCT和DSA对APF分型的相关性Kappa=0.779,u=10.17(P＜0.01);HCT和DSA对APF分型的一致性为85.42%.19例(19/48)肝癌伴中央型APF的患者接受介入栓塞治疗后11例APF消失,6例减轻,无效和APS再通各1例;29例(29/48)伴肝段型和周围型APF的肝癌患者经介入栓塞治疗后20例APF消失,8例减轻,1例无效.结论:HCT和DSA对APF的分型对于指导肝癌伴APF患者的介入治疗有一定意义.

Types of arterio-portal fistula of hepatocellular carcinoma patients on helical computed tomography and digital subtraction angiography

OBJECTIVE: To analyse the pathogenesis of the hepatocellular carcinoma (HCC) with arterio-portal fistula (APF) and the types of these APF on helical CT (HCT) and digital subtraction angiography (DSA), and to study the interventional therapy for HCC patients with APF. METHODS: HCC with APF in 48 patients were reported. All the patients received contrast media enhanced HCT scan and DSA examination. The APF were divided into the peripheral type, the hepatic segment type, and the center type according to the findings on HCT and DSA. RESULTS: The peripheral type of APF were found in 14 cases (14/48), the hepatic segment type in 15 cases (15/48), and the center type in 19 cases (19/48) on HCT scan, respectively. The peripheral type of APF were found in 13 cases (13/48), the hepatic segment type in 16 cases (16/48), and the center type in 19 cases (19/48) on DSA examination, respectively. The pertinency and consistency on the types of APF between HCT and DSA were compared, and the consistency rate was 85.42%; Kappa=0.779, u=7.60, P<0.01. It showed high pertinency of the types of APF between HCT and DSA. The center type APF in 11 of 19 cases disappeared, in 6 of the 19 cases partly disappeared, in 1 case was noneffective, and in 1 case was reformulation after the interventional therapy. The segment and peripheral types of APF in 20 of the 29 cases disappeared, in 8 of the 29 cases partly disappeared, and 1 case was noneffective after interventional therapy. CONCLUSION: It's vital to know well the features of various types of APF in HCC on HCT and DSA, which can bring about positive effect on interventional therapy for HCC with APF.