CTA在中晚期宫颈癌TACE治疗中的应用研究

目的分析CTA在中晚期宫颈癌经动脉导管内化疗栓塞(TACE)治疗中的应用价值。方法回顾性分析连续采集的50例中晚期宫颈癌患者(年龄26～70岁,平均46岁)的数据;研究对象按纳入时间顺序分成三组,对应每组的患者分别为20、20、10例。第1组的患者直接行DSA寻找明确靶血管后行TACE治疗;第2组在CTA协助下,配合DSA确定靶血管后行TACE治疗;第3组尽可能不做DSA,依靠透视和CTA判断靶血管再行TACE治疗。所有患者均在TACE前进行了CTA检查,两名放射诊断医师独立分析CTA得出统一结果。衡量三组患者TA-CE治疗效率;研究对比参数包括:手术时间、透视时间、患者的辐射剂量、对比剂剂量等;对参数进行t检验。结果经CTA和DSA判断46例患者的靶动脉为双侧子宫动脉,并进行了常规经双侧子宫动脉TACE治疗(第1、2、3组研究对象对应的病例数分别是20、16和10例)。4例患者CTA图像双侧子宫动脉显示不清,术中DSA显示子宫动脉细小,导管进入困难,后行双侧髂内动脉灌注化疗。研究患者共100支子宫动脉中有92支(92%)在CTA中清晰显示。第2、3组对比第1组患者,在CTA帮助下并且少用DSA可使经双侧子宫动脉TACE手术时间缩短,从90.2min缩短到50.5 min(P=0.036),术中透视时间从28.3 min缩短到17.5 min(P=0.032),剂量面积乘积从109.5Gy.cm2降低到24.5 Gy.cm2(P<0.001),对比剂用量从100.4 ml降至25.0 ml(P<0.001)。结论 CTA在中晚期宫颈癌TACE术中运用有助于识别靶动脉,提高TACE治疗效率。

The Application of CTA in the TACE Treatment of Advanced Cervical Cancer

Objective To discuss the value of compute tomography angiography in uterine artery chemoembolization(TACE) to advanced cervical cancer.Methods 50 consecutive women(mean age,46years;age range,26–70 years) who underwent TACE for advanced cervical cancer were divided chronologically into groups 1,2,or 3,which were composed of 20,20and 10 patients,respectively.Digital subtraction angiography was performed in groups 1 and 2 guided with CTA,as possible as less DSA in group 3.For all the groups,CT angiography was performed before TACE,and two radiologists assessed the results independently,and attached a unified conclusion.The parameters of the mean performance time,fluoroscopy time,dose area,contrast medium volume were compared among the three groups with the Tukey test.Results 50 patients received routine TACE through uterine artery which were seen as the target artery by CTA and DSA(20,16,and 10 patients in groups 1,2,and 3,respectively).Both uterine artery of 4 patients were not display clearly,afterwards they could be seen very thin by DSA,so they had both internal iliac artery arterial infusion chemotherapy.92(92%))of 100 uterine artery origins were demonstrated clearly by CT angiography.The assessment of CT angiographic results and discontinuation of digital subtraction angiography led to a reduction in the mean performance time [from 90.2 minutes to 50.5 minutes(P= 0.036)],fluoroscopy time [from 28.3 minutes to 17.5 minutes(P=0.032)],dose area [from 109.5 Gy·cm2 to 24.5 Gy·cm2(P< 0.001)],and contrast medium volume(from 100.4 mL to 25.0 mL(P< 0.001)].Conclusion CT angiography provides useful information to search target arteries,and improve the efficiency of TACE.