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目的探讨肝细胞癌合并门静脉主干癌栓时的肝动脉血流动力学变化。方法采用彩色多普勒超声对22例单纯肝细胞癌患者和26例肝细胞癌合并门静脉主干癌栓患者的肝固有动脉内径、收缩期最大血流速度以及阻力指数进行测定,并与正常对照组作对比。结果肝固有动脉内径:正常对照组0.33±0.05cm,单纯肝细胞癌组0.44±0.04cm,合并门静脉癌栓部分阻塞组0.45±0.04cm,合并门静脉癌栓完全阻塞组0.61±0.07cm。收缩期最大血流速度:正常对照组31.32±9.32cm/s,单纯肝细胞癌组66.76±20.34cm/s,部分阻塞组68.16±21.96cm/s,完全阻塞组132.65±38.84cm/s。阻力指数:正常对照组0.75±0.08,单纯肝细胞癌组0.68±0.13,部分阻塞组0.65±0.11,完全阻塞组0.55±0.10。经统计学处理,除部分阻塞组与单纯肝细胞癌组各项血流动力学参数无差异外(P>0.05),其它各组之间均存在差异(P<0.01)。结论肝细胞癌合并门静脉主干癌栓时,肝动脉血流量明显代偿性增加,阻力指数明显减低,但肝动脉血流动力学的这种改变主要取决于癌栓对门静脉主干的阻塞程度,而并不取决于门静脉癌栓的有无。
Objective To investigate the changes of hepatic artery hemodynamics in hepatocellular carcinoma with portal vein tumor thrombus. Methods Twenty-two patients with hepatocellular carcinoma and 26 patients with hepatocellular carcinoma with portal vein tumor thrombus were examined by color Doppler ultrasonography. The diameters of intrinsic hepatic artery, the maximum systolic velocity, and the resistance index were measured and compared with those of the normal control group For comparison. Results The diameter of hepatic artery was 0.33 ± 0.05cm in normal control group, 0.44 ± 0.04cm in simple hepatocellular carcinoma group, 0.45 ± 0.04cm in partially occluded portal vein tumor thrombus, and 0.61 ± 0.07cm in complete occlusion of portal vein tumor thrombus. The maximum systolic blood flow velocity was 31.32 ± 9.32cm / s in normal control group, 66.76 ± 20.34cm / s in simple hepatocellular carcinoma, 68.16 ± 21.96cm / s in partial occlusion group and 132.65 ± 38.84cm / s in complete occlusion group. Resistance index: 0.75 ± 0.08 in normal control group, 0.68 ± 0.13 in simple hepatocellular carcinoma, 0.65 ± 0.11 in partial obstruction group and 0.55 ± 0.10 in complete occlusion group. Statistically, there was no significant difference (P> 0.05) except hemodynamic parameters between partial occlusion group and simple hepatocellular carcinoma group (P <0.01). Conclusion Hepatocellular carcinoma with portal vein tumor thrombus, hepatic artery blood flow increased significantly compensatory, resistance index decreased significantly, but this change in hepatic artery hemodynamics depends mainly on the degree of tumor thrombus on the main portal vein obstruction, and Does not depend on the presence of portal vein tumor thrombus.