原发性肝癌自发破裂出血DSA特征及急诊动脉栓塞治疗  

DSA Characteristics and Emergency Transcatheter Arterial Embolization for Spontaneous Rupture and Hemorrhage of Primary Hepatocarcinoma

作　　者：谭小云[1] 陈德基[1] 何明基[1] 申刚[1] 李汉文[1] 王广宇[1] 

机构地区：[1]广州医学院第二附属医院放射科,广东广州510260

出　　处：《实用放射学杂志》2010年第6期879-882,917,共5页Journal of Practical Radiology

摘　　要：目的 探讨原发性肝癌自发破裂出血的DSA特征及其急诊动脉栓塞治疗效果.方法 回顾性分析经B超、CT及腹腔穿刺证实14例原发性肝癌自发破裂病例,根据DSA造影显示的情况,行肝动脉或肝外寄生动脉急诊介入栓塞治疗,并观察其临床疗效.结果 14例肝癌破裂出血患者中,10例为真性出血,即造影时显示肿瘤灶周对比剂外渗,4例为隐匿性出血,即造影显示肿瘤轮廓周边血管缺损区,未见明显对比剂外渗征象,其中2例可见肝-膈分离的征象.巨块型肝癌12例,结节型仅2例.癌肿块普遍较大,直径为3～20 cm不等.11例癌肿呈局限性凸出于肝实质,边界尚光滑,肝包膜完整 2例癌肿局限于肝实质内 另1例显示为完全破裂至腹腔.14例肝癌血供均很丰富,其中4例均存在肝外寄生血管.5例门脉左支或右支存在癌栓,门脉主干尚通畅.12例患者经1次栓塞后均得到有效止血 1例患者经连续2次栓塞后才成功止血 另1例栓塞治疗后止血不满意,后行外科手术切除.13例采用介入栓塞成功止血的患者待病情稳定后再多次行介入栓塞治疗,肿瘤均有不同程度缩小和坏死,未见再次破裂出血,无住院死亡者.结论 肝癌自发破裂出血有其自身DSA特征,同时也存在一定假阴性（本组病例占40%）,值得引起足够重视.急诊肝动脉栓塞是治疗原发性肝癌破裂出血的有效方法.Objective To explore DSA characteristics and the efficacy of emergency transcatheter arterial embolization（TAE） for spontaneous rupture and hemorrhage of primary hepatocarcinoma. Methods 14 cases of spontaneous ruptured heptatocarcinoma proved by ultrasonogram,CT or peritoneocentesis underwent TAE based on DSA features,and the therapeutic effect was evaluated. Results DSA showed contrast medium exudation in 10 cases but not in 4 cases,of them,2 cases had hepato-diaphragm ＂separating sign＂. The tumors included huge masses in 12 cases and nodular masses in 2 cases, with diameter ranged from 3 cm to 20 cm. 11 masses protruded locally outside the liver with smooth boundary and integral liver capsules, 2 masses localized inside the liver,and one tumor ruptured completely to abdominal. The tumors in all cases were of abundant blood supply and 4 had extrahepatic blood supply. The tumor＇s emboli at left or right portal vein were seen in 5 cases. BelIding was controlled in 12 cases after the first TAE and in 1 case after the second TAE,and one case underwent partial hepateetomy after TAE because the bleeding was not controlled satisfactorily. The tumors in 13 cases treated with TAE satisfactorily different degrees and no bleeding again. Conclusion DSA find- ings in spontaneous repture and hemorrhage of primary hepatocareinoma has its own characteristics, but there is probability of false- negative（40% in our cases）, which should be paid attention to. Emergency TAE is an effective method in therapy for spontaneous rupture and hemorrhage of primary hepatocarcinoma.

关 键 词：原发性肝癌 数字减影血管造影 介入治疗 动脉栓塞 

分 类 号：R735.7[医药卫生—肿瘤] R814.43[医药卫生—临床医学]