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目的探讨原发性肝癌切除术后早期DSA介入诊疗的影像表现特点。方法 45例原发性肝癌患者手术切除后行辅助性肝动脉化疗灌注或栓塞治疗,结合6个月随访期内CT及甲胎蛋白等资料,分析肝癌术后早期各种DSA影像表现及其诊断价值。结果早期DSA表现分为4类:(1)术后正常改变:27例。肝动脉及门静脉呈部分切除后改变,残肝动脉形态分布较规则,末梢血管增多并于切缘形成条片状或环形染色。(2)血管合并症:5例。并发肝动脉-门静脉瘘,见门静脉分支或主干提前显影。(3)肝内肿瘤复发/转移:10例。切缘复发肝动脉末梢增多杂乱,呈团块状或串珠状肿瘤染色;肝内复发/转移表现为单个或多发结节或团块影。碘油乳剂栓塞后杂乱血管消失,碘油明显沉积。(4)可疑肝内复发/转移:3例。肝动脉末梢增多较杂乱,碘油无明显沉积。DSA诊断术后复发/转移正确率为92.8%。结论原发性肝癌切除术后早期具有多种DSA表现,可以较准确地区分术后正常改变、血管合并症及肿瘤复发转移并指导介入治疗。
Objective To investigate the imaging features of early DSA interventional treatment after resection of primary liver cancer. Methods Forty-five patients with primary hepatocellular carcinoma received adjuvant hepatic arterial chemotherapy or embolization after surgical resection. Combining with CT and alpha fetoprotein during the 6-month follow-up period, various DSA imaging findings and diagnosis were analyzed in the early postoperative period. value. Results Early DSA manifestations were divided into 4 categories: (1) Normal postoperative changes: 27 cases. The hepatic artery and portal vein were changed after partial resection. The shape of the residual hepatic artery was more regular. Peripheral blood vessels increased and formed a strip-like or ring-shaped staining at the margin. (2) Vascular complications: 5 cases. Concurrent hepatic artery-portal fistula, see portal vein branch or trunk advance imaging. (3) Intrahepatic tumor recurrence/metastasis: 10 cases. Recurrence of recurrent hepatic arterial ends increased in clutter and showed lumps or beaded tumors; intrahepatic recurrence/metastasis showed single or multiple nodules or mass shadows. After the embolization of lipiodol emulsion, the blood vessels disappeared and the iodized oil was clearly deposited. (4) Suspected intrahepatic recurrence/metastasis: 3 cases. Peripheral hepatic arterial growth was more cluttered with no significant deposition of lipiodol. The correct rate of DSA diagnosis of recurrence/metastasis was 92.8%. Conclusion There are multiple DSA manifestations early after resection of primary liver cancer, which can accurately distinguish postoperative changes, vascular complications and tumor recurrence and metastasis and guide interventional therapy.