CO2肝动脉超声造影在诊断肝动—静脉瘘中的应用

对２２例原发性肝癌患者应用ＣＯ２肝动脉超声造影，结果发现５例在超声造影时见门静脉主干及／或左右分支内见微气泡流动，诊断为中央型肝动脉－门静脉瘘；１例在肝周围实质内有二条紧邻的平行光带流动，诊断为周围型肝动脉－门静脉瘘；２例肝静脉及下腔静脉肝后段内有微气泡流动，诊断为肝动脉－肝静脉瘘。而和Ｘ线血管造影作对照研究，则发现Ｘ线血管造影时，动脉相门脉主干早显者３例（属超声造影诊断的５例之中）；呈双轨征者３例；２２例Ｘ线血管造影时均未见肝静脉显影。由此可见，对周围型肝动脉－门静脉瘘，Ｘ线血管造影较为敏感。而对中央型肝动脉－门静脉瘘及肝动脉－肝静脉瘘，则ＣＯ２肝动脉超声造影较为敏感。因此，作者认为，ＣＯ２肝动脉超声造影对诊断肝动－静脉瘘有较大的价值，如果同Ｘ线血管造影相结合，可明显提高肝动－静脉瘘的检出率。

Clinical Application of CO 2 Hepatic Arterio-sonography(CO 2-HAS) in the Diagnosis of Intra hepatic Arteriovenous Shunts

CO 2-hepatic arterio-sonography (CO 2-HAS) was performed in 22 patients with liver carcioma. The results were: (1)with ultrasonographic angiography, in 5 patients, the folw of microbubbles showed in main portal branches was diagnosed as central type of hepatic arterio-portal shunts; in 2 patients, the flow of the microbubbles showed in hepatic veins and IVC was diagnosed as hepatic arterio-hepatic vein shunt; in 1 patient parallel flows of the microbubbles in peripheral portal branches and abutting hepatic artery showed simultaneusly, was diagnosed as peripheral type of hepatic arterio-portal shunt. (2)With X-ray angiography, in 3 patients, opacification of main portal branches showed during of following the arterial phase, was diagnosed as central type of hepatic arterio-portal shunt. None was diagnosed as hepatic arterio-hepatic vein shunt; But in 3 patients, early opacification of peripheral portal branches running parallel to the artery, was diagnosed as peripheral type of hepatic arterio-portal shunt. It is concluded that X-ray angiography is more sensitive in the diagnosis of peripheral type of hepatic arterio-portal shunt while ultrasonographic angiography is more sensitive in the diagnosis of central type of hepatic arterio-portal shunt and hepatic arterio-hepatic vein shunt. Ultrasonographic angiography can be used to compensate the insufficiency of X-ray angiography.