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  

Color Doppler Sonographic Diagnosis of Primary Hepatocellular Carcinoma Complicated with Hepatic Arteriovenous Fistula

作　　者：李莹莹[1] 段云友[1] 吕发勤[1] 苏红[1] 曹铁生[1] 曹玮[1] 袁丽君[1] 

机构地区：[1]解放军第四军医大学唐都医院超声科,西安市710038

出　　处：《中国超声医学杂志》2004年第10期767-770,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：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 5 1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 5 1例原发性肝癌患者超声检出 HAVF 1 5例 ,其中中央型肝动脉 -门静脉瘘 1 1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 .4 3± 0 .0 8) cmvs(0 .36± 0 .0 8) cm,t=2 .84 7,P=0 .0 0 6 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 .6 7± 34.4 0 ) cm/s;肝动脉阻力指数减低 [(0 .4 2± 0 .0 5 ) vs (0 .77± 0 .0 7) ,t=1 7.5 4 4 ,P=0 .0 0 0 ],搏动指数明显减低 [(0 .5 9± 0 .1 0 ) vs(1 .6 8± 0 .4 2 ) ,t=9.881 ,P=0 .0 0 0 ]。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 。Objective To study the ultrasonographic characteristics of hepatic ateriovenous fistula (HAVF) in patients with hepatocellular carcinoma and assess the ultrasonographic diagnostic evaluation in this disease and to establish an ultrasonographic standard.Methods Fifty one patients defined as hepatocellular carcinoma were enrolled in this study Their portal vein,hepatic vein,hepatic artery and vessels peripheral and inside the tumor were detected with two dimensional and Doppler ultrasonography,and the morphologic and hemodynamic indices were recorded Digital subtraction angiography (DSA) was used as golden standard and to judge whether there was HAVF or not.Results Out of 51 patients with hepatocellular carcinoma,15 cases had HAVF including 11 cases with central type of HAVF that blood flow was from hepatic artery to portal vein,3 cases with peripheral type that blood flow existed peripheral and inside the tumor and 1 patient with HAVF that blood flow was from hepatic artery to hepatic vein The central type showed some special features Firstly,hepatic artery diameters were larger than those of 36 patients without HAVF which was used as a control (0 43±0 08 cm vs 0 36±0 08 cm, t =2 847, P =0 0064) Secondly,in the venous lumen of HAVF there was aliasing mosaic flow on color Doppler and high velocity with low resistant flow spectrum which was reversal to arterial Finally,the spectral maximal velocity was 94 67±34 40 cm/s The hepatic arterial resistance index was lower than that of the control (0 42±0 05 vs 0 77±0 07, t =17 544, P =0 000) and also the pulsatility index (0 59±0 10 vs 1 68±0 42, t =9 881, P =0 000) Conclusions In patients with hepatocellular carcinoma with HAVF,color and spectral Doppler images of hepatic artery and vein showed characteristic changes These may be used as ultrasonic standard indices to diagnose HAVF in this kind of patients,which is beneficial for diagnosis,treatment and following up

关 键 词：肝动脉 原发性肝癌 患者 门静脉 临床应用 诊断 彩色多普勒超声 结论 真实性 指标 

分 类 号：R735.7[医药卫生—肿瘤]