肝细胞癌自发性破裂影像学检查的价值  

Evaluation of imaging examination in spontaneous rupture of hepatocellular carcinoma

作　　者：金洪 张金山[1,2,3] 马林 张解港[1,2,3] 赵长青 孙志丹[1,2,3] 袁克文 

机构地区：[1]解放军第二O五医院放射科 [2]解放军总医院放射科 [3]锦州医学院附属医院

出　　处：《中华放射学杂志》1998年第8期545-548,共4页Chinese Journal of Radiology

摘　　要：目的探讨与肝癌自发破裂出血相关的影像学征象及其在预测中的价值。方法搜集因肝癌死亡、影像学资料较齐全者５５例，根据有无肝破裂分为两组，破裂组２９例，非破裂组２６例，均行ＣＴ、ＭＲＩ等影像学检查。观察指标包括：肝硬化、腹水、肿瘤是否靠近肝脏边缘、肿瘤外凸及外凸程度、肿瘤最大截面积、形态学类型、包膜、中心坏死、肿瘤肝外侵犯、肿瘤血供、门脉癌栓、动静脉瘘等，并对上述资料进行统计学分析。结果肿瘤最大截面积、包膜、外凸及肝外侵犯两组比较有显著性差异（Ｐ＜０．０５）；肿瘤外凸弧长和外凸弓形面积两组比较有极显著性差异（Ｐ＜０．０１）。逐步Ｌｏｇｉｓｔｉｃ回归分析结果表明，肿瘤外凸和肝外侵犯为相对危险因素（ＲＲ＝４．８１和５．７４），与肿瘤破裂出血密切相关（Ｐ＜０．０５）。结论肿瘤外凸和肝外受侵与肝细胞癌自发性破裂出血有密切的相关性，可作为预测肿瘤破裂的指征。Purpose To evaluate the combined imaging findings of spontaneous rupture and hemorrhage in hepatocellular carcinoma(HCC)and the predictive value. Methods Twentynine patients in rupture group and 26 patients in nonrupture group were examined by CT and MR imaging. The observed items included the presence of hepatic cirrhosis and ascites, marginal tumor location and protrusion of the tumor, maximal tumor area, morphologic type of tumor, presence of capsule and central necrosis, presence of extrahepatic invasion, blood supply presence of tumor embolism in portal veins and arteriovenous shunt. Results Significant statistical differences were present in maximal tumor area, tumor capsule, tumor protrusion and extrahepatic invasion between rupture and nonrupture group(P<0.05), and very significant differences existed in maximal protrusion length and protrusion arcade area between the two groups(P<0.01). Stepwise logistic regression analysis showed that presence of tumor protrusion and extrahepatic invasion (relative risk, RR=4.81 and 5.74, respectively)correlated best(P<0.05 )with subsequent tumor rupture and hemorrhage. Conclusion The presence of tumor protrusion and extrahepatic invasion are closely related to tumor rupture and can be used in predicting spontaneous rupture and hemorrhage in HCC.

关 键 词：肝肿瘤 肝细胞癌 诊断 预后 

分 类 号：R735.704[医药卫生—肿瘤]