经皮肝穿刺活检联合动脉造影及栓塞技术在肝肿瘤诊疗中的应用(附46例报道)  

The application of percutaneous liver biopsy combined with artery angiography and transarterial embolization in diagnosis and treatments for liver tumors(a report of 46 cases)

作　　者：李国平[1] 王小林[1] 陈颐[1] 龚高全[1] 程洁敏[1] 李长煜[1] 施东华[1] 

机构地区：[1]复旦大学附属中山医院放射科,上海200032

出　　处：《复旦学报（医学版）》2012年第1期56-60,共5页Fudan University Journal of Medical Sciences

摘　　要：目的探讨超声导引或透视下经皮肝穿刺活检结合动脉造影技术在肝肿瘤诊疗中应用的安全性及可行性。方法选取难以明确诊断或欲知病理类型的肝占位患者共46例,肝穿刺活检前先行股动脉插管动脉造影,暂时保留导管于肿瘤动脉,用B超或透视导引下行肝穿刺活检。活检后再行一次动脉造影,判断有无穿刺道出血。如存在出血征象,则行肿瘤供血经导管动脉栓塞术(transcatheter arterial embolization,TAE)治疗,在栓塞完成后,再行最后一次动脉造影,显示肿瘤血供是否阻断以及出血是否停止。患者每次重复穿刺肝内病灶前,均用无水酒精纱布擦拭穿刺活检针,以避免穿刺道肿瘤种植。结果 46例患者肝穿刺活检均顺利完成,其中37例用B超导引,9例患者在透视下肝穿刺活检成功。46例患者共取出114条0.8～1.5cm细条组织,26例血管造影显示为富血供肿瘤,供血血管紊乱,不规则。4例肿瘤病灶较小,穿刺活检后造影显示造影剂弥散至瘤周并有小的门脉分支显影,考虑存在动静脉瘘或出血;3例显示造影剂外渗;此7例患者中有3例选用单纯超液化碘化油加明胶海绵颗粒行肿瘤血管栓塞,另4例选择了化疗栓塞。本组中共有36例患者术中明确诊断为恶性肿瘤,均对肿瘤进行了化疗栓塞,5例患者进行了单纯灌注化疗。大部分患者(80.4%)术后仅有轻度穿刺点疼痛,与穿刺时肝包膜刺激有关,均在术后第2～3天好转,无需使用镇痛剂;患者均未出现气胸、胸腔积液、腹膜炎;患者未出现穿刺道、肝包膜下出血及出血性休克等严重并发症表现。术后随访2个月未发现穿刺道肿瘤种植。穿刺活检阳性率为91.2%。结论在肝肿瘤诊疗中,经皮肝穿刺活检结合动脉造影及栓塞,可及时发现和治疗肝穿刺出血等并发症,是一种安全、可行的技术组合方案。Objective To discuss the security and feasibility of ultrasound or fluoroscopy-guided percutaneous liver biopsy combined with artery angiography and transarterial embolization in diagnosis and treatment of liver tumors. Methods Transarterial angiography was performed in 46 patients with difficultly diagnosed or unknown pathological type of liver tumors before liver biopsy.The catheter was kept in the artery of liver tumors temporarily.Then they received live biopsy guided by ultrasound or fluoroscopy.After the biopsy,another arterial angiography was carried out to detect if bleeding existed in needle tracks.Transcatheter arterial embolization（TAE） was performed if angiography showed bleeding.After embolization,a last arterial angiography was proceeded to confirm that blood supply was blocked and no bleeding existed.The needle was scrubbed with absolute alcohol cloth before every repeated puncture into the lesions of every patient. Results Liver biopsies in 46 patients were all successfully fulfilled.Among them,37 cases were guided by ultrasound, and 9 cases were under fluoroscopy.We got 114 slim tissuese with length of 0.8-1.5 cm from these patients.Angiography showed that tumor vessels in 26 pantients were rich and irregular.After the biopsy angiographies of 4 cases with small lesions showed that enhance agent extravasated around the tumors and little portal veins emerged in the early stage,which we considered as arteriovenous shunt or bleeding.Angiographies of 3 cases showed the extravasation of enhance agent.Three cases of the above mentioned seven patients＇ received were embolized with lipiodal and gelfoam sponge,and the other 4 cases chemoemboliztaion.Most patients（80.4%） felt slight pain at puncture points and recovered 2-3 days later without any anodyne.No patients suffered from pneumothorax,pleural effusions and peritonitis.There was no patients evolving severe complications such as bleeding and exsanguine shock.No tumor implantation was found in needle tracks during follow-up of 2 months.Positi

关 键 词：经皮肝穿刺活检术 动脉造影 经导管动脉栓塞术 肝肿瘤 

分 类 号：R730.4[医药卫生—肿瘤]