DynaCT在原发性肝癌患者经肝动脉化疗栓塞术中的指导作用及对疗效的评估价值  

Guiding role of cone beam CT with DynaCT in transcatheter arterial chemoembolization for patients with primary liver cancer and its value in assessing treatment outcome

作　　者：杨怀龙 钟唐力[2] YANG Huailong;ZHONG Tangli(Department of Radiology,Sichuan Mianyang No.404 Hospital&The Second Affiliated Hospital of North Sichuan Medical College,Mianyang,Sichuan 621000,China;Department of Radiology,Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]四川绵阳四〇四医院(川北医学院附属第二医院)影像科,四川绵阳621000 [2]四川绵阳市中心医院放射科,四川绵阳621000

出　　处：《临床肝胆病杂志》2022年第4期851-856,共6页Journal of Clinical Hepatology

基　　金：四川省自然科学基金(2019SC089)。

摘　　要：目的探讨分析肝癌经肝动脉化疗栓塞术(TACE)治疗患者采用DynaCT的效果及对患者预后的影响。方法选择2017年5月—2019年5月在川北医学院附属第二医院就诊的原发性肝癌患者73例,将患者随机分为观察组(n=38)和对照组(n=35)。对照组患者仅行2D-DSA造影下TACE治疗,观察组患者在2D-DSA造影后再行DynaCT造影。比较两组患者手术时间、X线曝光量以及造影剂用量,2D-DSA造影与DynaCT造影对肝内肿瘤病灶检出情况及供血动脉显示情况,二维X线透视与平扫DynaCT对肿瘤病灶内碘化油沉积的评估。两组间计量资料比较采用独立样本t检验,计数资料两组间比较采用χ^(2)检验;绘制Kaplan-Meier生存曲线分析生存情况,两组间比较采用log-rank检验。结果两组患者手术时间、X线曝光量以及造影剂用量比较差异均无统计学意义(P值均>0.05)。观察组患者中共检出肿瘤病灶93个,病灶供血动脉阳性占比为84.95%(79/93),对照组患者中共检出肿瘤病灶61个,病灶供血动脉阳性占比为55.74%(34/61),观察组患者病灶中供血动脉检出阳性占比显著高于对照组(χ^(2)=16.088,P<0.05)。术后对两组患者的113个病灶进行碘化油沉积分析,二维X线透视显示89个病灶碘油均匀沉积,24个病灶碘油部分或全部缺失;而平扫DynaCT显示78个病灶碘油均匀沉积,35个病灶碘油部分或全部缺失。观察组患者术后总体生存情况显著优于对照组(χ^(2)=4.347,P=0.037)。结论DynaCT在不增加术中X线曝光量与术中造影剂使用量的同时,能够提高对肝内乏血病灶和重叠病灶的检出率,从而提高插管准确性,减少患者血管损伤,同时也可应用于栓塞术后碘化油沉积评价,在肝癌TACE术中具有重要的应用价值,有助于改善患者术后生存。Objective To investigate the effect of cone beam CT with DynaCT on liver cancer patients undergoing transcatheter arterial chemoembolization(TACE)and its influence on the prognosis of patients.Methods A total of 73 patients with primary liver cancer who attended The Second Affiliated Hospital of North Sichuan Medical College from May 2017 to May 2019 were enrolled and randomly divided into observation group with 38 patients and control group with 35 patients.The patients in the control group underwent TACE under 2D-DSA angiography,and those in the observation group underwent DynaCT angiography after 2D-DSA angiography.The two groups were compared in terms of time of operation,X-ray exposure,amount of contrast agent used,intrahepatic tumor lesions detected and blood supplying arteries displayed by 2D-DSA angiography versus DynaCT angiography,and lipiodol deposition in tumor lesions evaluated by postoperative two-dimensional X-ray fluoroscopy versus plain DynaCT scan.The two-independent-samples t test was used for comparison between two groups,and the chi-square test was used for comparison of categorical data between two groups;the Kaplan-Meier survival curve was plotted for survival analysis,and the log-rank test was used for comparison between two groups.Results There were no significant differences between the two groups in time of operation,X-ray exposure,and amount of contrast agent used(all P>0.05).For the observation group,a total of 93 tumor lesions were detected,among which 79(84.95%)were positive for blood supplying arteries,while in the control group,a total of 61 tumor lesions were detected,among which 34(55.74%)were positive for blood supplying arteries,suggesting that the proportion of lesions positive for blood supplying arteries in the observation group was significantly higher than that in the control group(χ^(2)=16.088,P<0.05).After surgery,113 lesions of the two groups were analyzed for lipiodol deposition;two-dimensional X-ray fluoroscopy showed that lipiodol was evenly deposited in 89 lesions

关 键 词：肝肿瘤 化学栓塞 治疗性 血管造影三维软组织成像技术 

分 类 号：R735.7[医药卫生—肿瘤]