用数字减影血管造影观察中晚期原发性肝癌血液动力学改变的临床意义

作者对100例中晚期原发性肝癌数字减影血管造影(DSA)的影像表现进行了动态观察分析。结果中晚期原发性肝癌血液动力学发生明显改变:肝动脉血供比例增大(肝总动脉>脾动脉68例);门静脉血回流受阻(肝外门脉延迟显影和不显影68例);瘤区动脉血异常引流(肝动脉血向门静脉分流35例,向肝静脉分流2例,向下腔静脉分流2例)。肝癌的大小、门脉受侵、瘤栓、A-V分流是影响血液动力学改变的重要因素,观察分析上述因素对判断预后、制定介入治疗方案、评价疗效有重要的临床价值。认为DSA不仅用于肝癌的诊断,而且是观察研究中晚期肝癌血液动力学的有效方法之一。

Digital subtraction angiography observation on clinical significance of hemodynamical changes in the mid and late period of primary hep-atoma

One hundred cases of DSA imaging manifestation of the mid and late period of primary hepatoma were observed dynamically. The authors considered that DSA was not only used for diagnosis of hepatoma, but also was one of the effective method to observe and analyse the change of the hemodynamics in the mid and late period of primary hepatoma. Obvious change occured in the hemodynamics of the mid and late period of primary hepatoma: the increasing proportion of blood supply of hepatic artery (common hepatic artery was thicker than the spleen artery, 68 cases); the obstruction of portal vein return (extrahepatic portal vein delays developing or doesn't develop, 68 cases); the abnormal arterial blood supply in tumor zone (the hepatic artery shunts into portal vein. 35 cases; it shunts into hepatic vein 2 cases; it shunts into vena cava inferior 2 cases). The important factors to affect the change of hemodynamics were the size of hepatoma, portal vein invaded, thrombus of hepatoma and A-V shunting. Observation and analysis of the above factors have important clinical value for judging prognosis, facilitating the intervenient treatment scheme, and evaluating the curative effect.