CAJ | 학술논문

目的：探讨双能量 CT 血管成像( DECTA)与 DSA 在原发性肝癌经导管化疗栓塞(TACE)术中协同应用的价值。方法前瞻性分析2013年8月—2014年8月复旦大学附属华东医院放射科采用 TACE 术治疗的98例原发性肝癌患者的临床资料，其中男70例，女28例，年龄47~84岁。按照完全随机化分组设计将患者随机分为2组：对照组48例，在 TACE 术前不行 DECTA 检查；观察组50例，在 TACE 术前行 DECTA 检查，并行 VR、最大密度投影(MIP)和多平面重建(MPR)。对2组患者术中查找肿瘤供血动脉数量、术中选用导管数量、对比剂用量、减影采集序列次数、透视时间、手术时间、剂量辐射乘积和超选程度进行对比分析。结果98例均完成检查和 TACE 术。2组TACE 术的超选程度差异无统计学意义(P >0.05)，但在查找肿瘤供血动脉数量上，观察组(2.72±0.89)条多于对照组(1.88±0.74)条，差异有统计学意义(P <0.01)；在选用导管数量、对比剂用量、减影采集序列次数、透视时间、手术时间和剂量辐射乘积方面，观察组均少于对照组，差异均有统计学意义(P 值均<0.05)。对腹腔动脉变异及肝外寄生血管为肿瘤提供血供的显示，观察组也优于对照组。观察组未出现手术并发症，而对照组中有4例术中出现上腹部急性疼痛。结论 DECTA 与 DSA在原发性肝癌介入治疗中的协同应用是合理、可行的操作方案。
목적：탐토쌍능량 CT 혈관성상( DECTA)여 DSA 재원발성간암경도관화료전새(TACE)술중협동응용적개치。방법전첨성분석2013년8월—2014년8월복단대학부속화동의원방사과채용 TACE 술치료적98례원발성간암환자적림상자료，기중남70례，녀28례，년령47~84세。안조완전수궤화분조설계장환자수궤분위2조：대조조48례，재 TACE 술전불행 DECTA 검사；관찰조50례，재 TACE 술전행 DECTA 검사，병행 VR、최대밀도투영(MIP)화다평면중건(MPR)。대2조환자술중사조종류공혈동맥수량、술중선용도관수량、대비제용량、감영채집서렬차수、투시시간、수술시간、제량복사승적화초선정도진행대비분석。결과98례균완성검사화 TACE 술。2조TACE 술적초선정도차이무통계학의의(P >0.05)，단재사조종류공혈동맥수량상，관찰조(2.72±0.89)조다우대조조(1.88±0.74)조，차이유통계학의의(P <0.01)；재선용도관수량、대비제용량、감영채집서렬차수、투시시간、수술시간화제량복사승적방면，관찰조균소우대조조，차이균유통계학의의(P 치균<0.05)。대복강동맥변이급간외기생혈관위종류제공혈공적현시，관찰조야우우대조조。관찰조미출현수술병발증，이대조조중유4례술중출현상복부급성동통。결론 DECTA 여 DSA재원발성간암개입치료중적협동응용시합리、가행적조작방안。
Objective To evaluate the synergistic effect of dual-energy computed tomography angiography ( CTA) and digital substraction angiography ( DSA) on transcatheter chemoembolization of hepatocellular carcinoma. Methods Transcatheter chemoembolization was performed in 98 patients with hepatocellular carcinoma from Aug. 2013 to Aug. 2014. The patients were divided into two groups randomly. Fifty patients underwent dual-energy CTA before transcatheter chemoembolization were regarded as group 1 with post-procession of VR, MIP and MPR; meanwhile other 48 patients were regarded as group 2 without CTA. The number of tumor-feeding vessels and used catheters, dose of contrast medium, amount of DSA series, time of exposure and operation, dose area product, and degree of transcatheter chemoembolization were compared. Results All tumor-feeding vessels in group 1 were observed by dual-energy CTA clearly with exact display of the origin, course, and diameter of the vessels. The number of tumor-feeding vessels in group 1 was 2. 72 ± 0. 89,more than that in group 2(1. 88 ± 0. 74), exhibiting a statistical difference between two groups ( P < 0. 01). The number of catheters used, dose of contrast medium, amount of DSA series, time of exposure and operation, and dose area product in group 1 were less than those in group 2, also exhibiting the statistical difference ( all P values < 0. 05). Conclusions Combination of dual-energy CTA and DSA is reasonable and practicable, which has synergistic effect on interventional therapy for hepatocellular carcinoma.