肝动脉多普勒血流灌注指数与超声造影联合检查肝转移灶的价值

目的 探讨肝动脉多普勒血流灌注指数与超声造影早期联合检查肝转移灶的价值.方法 收集655例非肝恶性肿瘤且术前常规超声检查未发现肝转移性灶的患者,常规超声检查同时行肝动脉多普勒血流灌注指数(DPI)检测,肝动脉DPI升高者再顺序行实时超声造影检查及增强CT检查.所有患者均经手术、超声引导下穿刺活检或随访证实.结果 655例患者中肝动脉DPI未升高562例,随访6个月内发现肝转移灶19例,肝动脉DPI预测肝转移的阴性预测值96.6％(543/562).肝动脉DPI升高(DPI＞30％)93例,6个月内共检出有肝转移者75例,肝动脉DPI预测肝转移的阳性预测值80.6％(75/93).93例肝动脉DPI升高的患者,超声造影检出肝转移者75例,转移灶132枚,增强CT检出肝转移者60例,转移灶94枚,两者比较差异有统计学意义(P＜0.01).结论 联合常规超声检查、肝动脉DPI检测及超声造影检查可显著提高超声对肝转移灶的早期检出率.     

多普勒肝脏灌注指数对肝硬化早期癌变的诊断价值

目的 探讨超声检测肝动脉多普勒血流灌注指数（△DPI）和肠系膜上动脉与肝动脉血流阻力比（△RR）血流参数的动态变化早期诊断肝硬化癌变的临床应用价值。方法选取临床诊断为肝硬化的乙肝患者178例,应用超声定期检查△DPI、△RR血流参数,直至患者被影像检查及临床诊断为肝硬化癌变,计算DPI、RR的动态变化值△DPI、△RR,进而计算△DPI、△RR动态变化的百分比。结果 从肝硬化发展为癌变的32例患者的△DPI、△RR初检至癌变前无明显变化（P〉0.05）,出现癌变时飞跃性增加（P〈0.05）,且△DPI%、△RR%的95%参考值范围与癌变前的测值范围无重叠。结论 肝动脉多普勒血流灌注指数（△DPI）与阻力比（△RR）等血流参数的动态变化可作为早期诊断肝硬化癌变的可靠参数。     

彩色多普勒超声在肝脏肿块中的诊断价值

目的探讨彩色多普勒超声(CDFI)在肝脏肿块中的诊断价值。方法回顾性分析68例肝脏肿块病变患者的超声资料,评估CDFI的诊断价值。结果 CDFI显示肝血管瘤(n=43)无血流信号;原发性肝癌(n=13)血流信号丰富,动脉流速较高,阻力指数较大;转移性肝癌(n=12)在瘤体外围有较少的彩色血流信号。原发性肝癌及转移性肝癌患者血流灌注指数(DPI)、门静脉充血指数(PCI)、阻力比(RR)以及肝总血流量(TLBF)明显高于肝血管瘤患者(均P<0.05)。结论 CDFI在肝脏肿块中的诊断价值较大。     

彩色多普勒超声对原发性肝癌肝动-静脉瘘诊断的临床应用

目的探讨原发性肝癌患者肝动-静脉瘘(HAVF)的超声图像特征,评价超声对该病的诊断价值,建立超声诊断HAVF标准值.方法二维及多普勒超声观察临床确诊的51例原发性肝癌患者的门静脉、肝静脉、肝动脉以及肝周、肿瘤周围及瘤体内部血管走行及血流形态,测定相关形态及血流动力学指标 .以数字减影血管造影(DSA)作为金标准,确定HAVF存在的真实性.结果本组51例原发性肝癌患者超声检出HAVF 15例,其中中央型肝动脉-门静脉瘘11例,周围型肝动脉-门静脉瘘3例,肝动脉-肝静脉瘘1例.中央型肝动脉-门静脉瘘超声表现为:(1)与本组36例无HAVF患者肝动脉比较,其内径增宽[(0.43±0.08)cm vs(0.36±0.08)cm,t=2.847,P＝0.006 4];(2)彩色多普勒超声见发生瘘的静脉内出现五彩镶嵌血流束;(3)脉冲多普勒于发生瘘的静脉内可测得"高速低阻"型反向脉动样血流频谱,Vmax为(94.67±34.40)cm/s;肝动脉阻力指数减低[(0.42±0.05) vs (0.77±0.07),t=17.544,P＝0.000],搏动指数明显减低[(0.59±0.10)vs(1.68±0.42),t=9.881,P＝0.000].结论 HAVF患者肝动脉的内径、发生瘘的静脉腔内彩色及频谱多普勒指标呈特征性变化,可作为超声检测原发性肝癌HAVF标准值,以便于该病的临床诊断、治疗及治疗后随访.     

彩色多普勒超声在肝脏占位性病变诊断中的临床研究

目的:分析彩色多普勒超声在肝脏占位性病变诊断中的临床实践意义。方法:以我院2017年10月--2019年10月抽样选取的99例肝脏占位性病变患者为研究对象,均开展彩色多普勒超声检查。结果:彩色多普勒超声的肝硬化增生结节、肝硬化增生结节、转移性肝癌、原发性肝癌检出率及肝脏占位病变总检出率与病理检查结果无较大差异(P>0.05)。转移性与原发性肝癌患者血流灌注指数(DPI)与阻力指数(RR)明显高于肝硬化增生结节、肝血管瘤患者(P<0.05)。肝硬化增生结节患者静脉充血指数(PCI)与肝总血流量(TLBF)明显高于肝血管瘤、转移性肝癌、原发性肝癌患者(P<0.05)。结论:在肝脏占位性病变诊断中彩色多普勒超声的实践价值较为突出,值得广泛应用。     

肝硬化并发肝癌病例中的肝动脉峰值流速与阻力指数的动态变化

目的探讨超声检测肝动脉血流峰速度(Vmax)与阻力指数(RI)的动态变化早期诊断结节性肝癌(肿块的直径在1cm以下)的临床应用价值;方法选取临床诊断为肝硬化的乙肝患者150例,应用超声定期检查肝动脉的Vmax、RI,直至患者被影像检查及临床诊断为结节性肝癌,计算Vmax、RI的动态变化值⊿Vmax、⊿RI,进而计算⊿Vmax、⊿RI动态变化的百分比;结果从肝硬化发展为结节性肝癌的23例患者的肝动脉Vmax、RI初检至癌变前无明显变化(P>0.05),出现结节性肝癌时飞跃性增加或降低(P<0.05),且⊿Vmax%、⊿RI%的95%参考值范围与癌变前的测值范围无重叠;结论肝动脉Vmax、RI等血流参数的动态变化是早期诊断结节性肝癌的可靠参数。     

肝动脉血流量与门静脉血流量之比对肝癌的诊断价值

目的:探讨肝动脉血流量(Qh)与门静脉血流量(Qp)之比对肝癌的诊断价值.方法:选择2005年1月～2007年6月我院收治的肝癌49例、肝硬化114例,作为肝癌组和肝硬化组;选择同期无肝脏疾病者47例为健康对照组.3组均应用超声检测Qh及Qp,并对检测结果进行统计学分析.结果:肝癌组Qh与Qp比值(Qh/Qp)明显高于肝硬化组、对照组(P＜0.05),Qh/Qp的骤然增加是肝癌组的特异表现;若以肝癌组Qh/Qp的95%可信区间的下界作为诊断肝癌的标准,其敏感性、特异性、阳性预测值分别为94.4%、100.0%、100.0%.结论:Qh/Qp骤然增加可提示肝癌的可能,比例＞0.33可作为肝癌诊断的参考值.     

彩色多普勒超声在肝脏占位性病变中的诊断价值

目的探讨彩色多普勒超声在肝脏占位性病变诊断中的临床价值。方法对62例经CT或者病理检查证实的肝脏占位性病变患者（其中原发性肝癌的18例,转移性肝癌14例,肝血管瘤22例,肝硬化增生结节8例）采用彩色多普勒超声进行检查。结果原发性和转移性肝癌患者血流灌注指数（DPI）、阻力比（RR）值均显著高于肝血管瘤以及肝硬化增生结节患者（P〈0.05）,肝硬化增生结节患者门静脉充血指数（PCI）、肝总血流量（TLBF）值均显著高于其他肝脏占位性病变患者（P〈0.05）。结论彩色多普勒超声可提供多个血流参数指标,显著提高对肝脏占位性病变的诊断和鉴别水平。     

肝动脉多普勒血流灌注指数对肝硬化结节性病灶的鉴别诊断价值

目的 探讨肝动脉多普勒血流灌注指数(DPI)对肝硬化患者结节性病灶的鉴别诊断价值。方法 选择79例肝硬化伴结节性病灶的患者，应用超声检测肝动脉DPI，以DPI≥0．30为诊断肝硬化结节性病灶为癌性结节的标准。结果 79例患者中33例结节性病灶为癌病灶，其余46例为良性病灶；依据DPI诊断肝硬化结节性病灶为癌性结节的敏感性为90．9％、特异性为89．1％、准确性为89．9％、阳性预测值为85．7％、阴性预测值为93．2％。结论 DPI可作为临床诊断与鉴别诊断肝硬化结节良恶性的可靠参数。     

超声造影与彩色多普勒超声对肝实质性肿块诊断价值

目的比较彩色多普勒超声和实时超声造影在肝实质性肿块中的诊断价值。方法应用彩色多普勒超声及超声造影技术对常规二维超声难以定性的29例患者共33个肝实质性肿块进行检查,结果与手术及病理结果相对照。结果33个肿块中原发性肝细胞性肝癌24个,肝血管瘤3个,肝脏局灶性结节增生3个,局限性脂肪肝2个,肝孤立性坏死结节1个。彩色多普勒超声在肿块内部或肿块周边能检测到动脉血流频谱者共19例21个肿块;超声造影除一例肝孤立性坏死结节外,其余32个病灶均在不同时相出现不同程度强化现象。如以动脉相呈高回声而门脉相及延迟相呈低回声为恶性肿块的诊断标准,则超声造影对肝癌诊断的准确性为92%;如以肿块内部检测到动脉样血流频谱为诊断恶性肿块的诊断标准,则彩色多普勒超声诊断肝癌的准确性为75%,二者差别有显著性(P<0.05)。结论实时超声造影显著提高肝实质性肿块诊断的准确性,对肝脏实质性肿块良、恶性的诊断及鉴别诊断具有重要价值。     

异位辅助肝移植治疗急性肝功能衰竭的实验研究

目的：探讨异位辅助性部分肝移植治疗急性肝功能衰竭的可行性。方法；制作息性肝功能衰竭犬动物模型26只。分为两组：移植组20只，对照组6只。移植组切除脾脏后，于脾窝处移植同系异体60％部分肝脏，手术成功17只。观察两组实验动物的存活时间、血液生化、残肝磁共振（MRI）检查、残肝和移植肝的组织细胞形态改变。结果：对照组和移植组实验动物72h存活率分别为16．7％和82．7％。移植术后2周残肝细胞明显增生，肝功能恢复近正常，而辅助肝渐萎缩，术后5周辅助肝完全纤维化。结论：急性肝功能衰竭时，异位辅助性部分肝脏移植可为病肝提供暂时性功能支持，为残肝细胞再生、功能恢复提供机会，同时移植肝渐萎缩、纤维化。     

MR imaging of traumatic hepatic laceration: Evaluation and course of healing after surgery

Six patients with hepatic laceration underwent magnetic resonance imaging (MRI) at 0.5T. Acute hepatic laceration was slightly hypointense on T1-weighted spin-echo (SE) image, and hyperintense on T2- and proton-weighted SE images. Subacute laceration was heterogeneously intense on T1-weighted image and hyperintense on T2- and proton-weighted images. Consistent changes in signal intensity of postoperative hepatic laceration were observed. On Tl-weighted image, the signal intensity at first increased and then decreased from periphery to the center. On the T2- and proton-weighted images, the laceration was uniformly hyperintense relative to the liver prior to the appearance and growth of a hypointense ring at its periphery. The appearance of the above changes in signal intensity was also observed in postoperative recurrent hemorrhage. The postoperative biloma had none of the above changes in signal intensity. Our cases show that MRI is effective in the evaluation of hepatic laceration and in the assessment of the course of healing after operation.     

三维MRA技术在肝脏血管成像中的应用研究

目的：探讨三维增强MRA（3D CEMRA）技术在肝脏磁共振血管成像中的应用价值。方法：52例行肝脏磁共振血管成像患者及30例对照组病人，利用自动透视触发技术进行肝脏血管成像，造影剂到达降主动脉起始段时启动3D扫描，扫描时相包括肝动脉期、门静脉期及腔静脉期，分离各组图像并与蒙片剪影，再进行最大信号强度投影（MIP）及多平面图像重建（MPR），评价各期图像质量。结果：采用3DCEMRA技术所获肝动脉期及门静脉期图像质量满意；造影剂到达降主动脉起始段时间与造影剂流速、总量之间呈线性相关；造影剂总量和流速与肝血管信号强度呈正相关。结论：3DCEMRA技术可准确把握造影剂到达靶血管时间，结合最佳的造影剂总量和注射速度，明显提高肝脏磁共振血管成像质量。     

Intraoperative sonography of hepatocellular carcinoma: Detection of lesions and validity in surgical resection

Eighty-six hepatocellular carcinomas (HCCs) in 67 patients were examined by intraoperative sonography. Sensitivity for detecting tumors with intraoperative sonography was compared with sonography, computed tomography (CT), hepatic angiography, and CT after intraarterial injection of iodized poppy-seed oil (Lipiodol-CT). The overall sensitivities were 76% with sonography, 86% with CT, 89% with angiography, 96% with Lipiodol-CT, and 98% with intraoperative sonography. The differences in sensitivity between intraoperative sonography and sonography (p < 0.01), CT (p < 0.01), and angiography (p < 0.05) were significant. In 35 lesions smaller than 2 cm, the sensitivities of Lipiodol-CT and intraoperative sonography were high (91 and 94%, respectively). In operating field, tumors were invisible in 36 (42%) and nonpalpable in 31 of 86 cases (36%). In 35 tumors smaller than 2 cm, invisible tumors were 66% and nonpalpable tumors were 63%. However, 84 of 86 cases (98%) could be localized with intraoperative sonography.These results suggest that intraoperative sonography is the final diagnostic imaging procedure before surgical resection of tumors and in cases of invisible and nonpalpable tumors in the operating field, this procedure is mandatory to improve surgical results.     

Undifferentiated embryonal sarcoma of the liver treated with chemotherapy: CT imaging in four patients

Background: The purpose of this study was to describe the computed tomography (CT) findings of undifferentiated embryonal sarcoma after chemotherapy and to correlate the CT imaging findings with pathologic findings. Methods: Ten CT images obtained before and after chemotherapy in four patients with hepatic undifferentiated embryonal sarcoma were retrospectively reviewed and correlated with pathologic findings. Results: After chemotherapy, tumor volume decreased by 50–90% and initially nonresectable tumor or gross residual tumor was successfully excised in three patients. In all patients, enhancing peripheral solid portions and septations changed to low-attenuation areas, and in three patients increased or de novo calcifications were found at the periphery of the tumor. Resected pathologic specimen after chemotherapy showed well-encapsulated masses with central necrosis, fibrosis, and dystrophic calcifications. Conclusions: These CT findings will be useful in monitoring the treatment response of hepatic undifferentiated embryonal sarcoma during chemotherapy.     

二维及多普勒超声在肝囊性占位性病变鉴别诊断中的应用

目的　探讨超声对不典型肝囊肿、肝脓肿和肝囊肿型恶性肿瘤的鉴别诊断价值。方法　对经活检或手术明确诊断的 87例肝占位性病变声像图特征进行了分析 ,其中包括 17例肝囊肿型恶性肿瘤 ,2 2例肝脓肿和 48例肝囊肿。声像图上根据病变的形态、病灶数目、囊壁厚度、囊内分隔、囊壁结节、彩色多普勒表现、囊内回声及边界特征进行评分。比较三组患者的声像图表现差异。结果　肝囊肿型恶性肿瘤、肝脓肿及肝囊肿声像图表现的差异具有显著性意义 (P <0 .0 5 ) ,其积分值分别为 8.76± 2 .5 2、6.86± 1.88和 0 .97± 1.3 3。肝囊肿型恶性肿瘤和肝脓肿在囊壁结节、囊内分隔、囊壁或分隔内测得血流和囊液透声性方面差异存在显著性意义 (P <0 .0 1) ,而在病灶形态、囊壁厚度、病灶数目和边界特征方面差异无统计学意义 (P >0 .0 5 )。不同病理类型的肝囊肿型恶性肿瘤的声像图表现无显著差异。结论　肝囊肿型恶性肿瘤、肝脓肿及肝囊肿声像图表现具有差异 ,病灶内出现分隔、囊壁内出现壁结节、囊壁或分隔内测及动脉样血流有利于肝囊肿型恶性肿瘤的诊断     

肝移植受体血管重建术前MSCT评价

目的 探讨MSCT在肝移植受体术前评估中的作用。方法 应用MSCT行动脉期、门静脉期和延迟期增强扫描,采用最大密度投影(MIP)、表面遮盖显示(SSD)和容积重建(VR)方法进行肝动脉、肝静脉和门静脉血管重建,测量肝总动脉、腹腔动脉干及门静脉直径。结果 120例肝移植受体中肝细胞癌23例,其中肿块型11例、结节型9例、弥漫型3例。肝硬化89例,其中13例合并肝癌,肝动脉细小、扭曲21例(直径≤3 mm)。腹腔干狭窄6例,其轻-中度狭窄5例,重度狭窄1例。门静脉癌栓11例,其中长度癌栓4例,癌栓局限门静脉主干7例。肝硬化门静脉高压症侧支循环血管形成24例,存在侧支循环表现39例。下腔静脉血栓形成4例。结论 MSCT能显示肝脏动静脉、门静脉的解剖结构,明确肝脏病变,能为肝移植受体提供综合的术前评估,对手术术式的设计及预后有重要意义。     

人工肝支持系统在肝衰竭中的应用经验和进展

人工肝支持系统对肝衰竭的治疗作用已经得到公认,可以使部分患者病情得到恢复,还可以使患者有效地过渡到肝脏移植,分为非生物型人工肝、生物型人工肝和混合型3种,包括血浆置换、血液滤过、血液/浆灌流、连续性血液透析滤过、血液透析、白蛋白透析、血浆胆红素吸附和生物型人工肝等。目前常应用的方法有血浆置换、连续性血液透析滤过和血浆胆红素吸附,其作用机制就是通过机械性的方法祛除肝衰竭患者体内的毒性物质及代谢产物,补充部分活性物质,纠正凝血物质缺乏,使患者内环境改善,利于肝细胞再生,病情恢复。     

Hepatocellular carcinoma with or without cirrhosis: A comparison of CT and angiographic presentations in the United States and Japan

We compared the computed tomographic (CT) and angiographic presentations of hepatocellular carcinoma (HCC) with or without cirrhosis in the United States and Japan. Tumors in the United States were advanced and less frequently associated with liver cirrhosis (association of cirrhosis: United States) 56.2%, Japan 91.0%. In patients with cirrhosis, the size of the tumor tended to be smaller, and nodular tumors (single or multiple) were frequent. In early stage of HCCs with cirrhosis, tumors were hypovascular without a capsule. In advanced stage, tumors were hypervascular and a capsule was frequently observed around the tumor both with CT and angiography. HCCs without cirrhosis were seen in younger patients. These tumors were large at the time of diagnosis. A massive or diffuse mass without a capsule was frequently seen. Most tumors were hypodense on precontrast CT and hypervascular on angiography. Lymph node enlargement was significantly frequent. The radiological characteristics of HCC in both countries were significantly different depending upon associated cirrhosis, as well as the time of the diagnosis.     

肝移植术后供肝功能的恢复观察

目的通过动态监测肝移植术后3个月内与肝功能有关的9项生化指标的水平,判定供体肝脏在受体内功能完全恢复所需要的时间。方法选择本院2003年至2005年行肝移植术的病例,自术后第2天起定期清晨采集患者静脉血进行血清ALT、AST、GGT、ALP、GLDH、CHE、ALB、PAB及CHOL测定,最长监测时间90天。然后回顾性筛选出术后未发生各种并发症的病例进行统计学分析,设正常对照组。结果血清GGT、ALP,血清AST、ALB,血清ALT、GLDH、PAB和血清CHE、CHOL分别在术后第2天,第10天,第12天和第90天恢复至正常对照组水平。结论结果提示肝移植术后供体的肝功能要完全恢复到正常人水平约需3个月时间。