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目的探讨肝海绵状血管瘤(CHL)动脉造影表现分型及其临床意义。资料与方法102例CHL患者,男35例,女67例,年龄23～70岁,平均41.3岁。所有患者行肝动脉造影:导管位于肝固有动脉水平,对比剂注射流率5ml/s,DSA连续完整采集动脉期、实质期图像。按照下述标准将动脉造影表现分为4型:富血型(Ⅰ型),乏血型(Ⅱ型),动静脉分流(AVS)型(Ⅲ型),门静脉供血型(Ⅳ型)。各型判定标准:富血型为供血动脉轻-中度增粗,动脉期可见较多异常血窦显影,实质期异常血窦充盈瘤体大部分区域。乏血型为供血动脉无增粗,动脉期可见数量不多的异常血窦在瘤体周边显影,实质期异常血窦充盈瘤体小部分区域。出现AVS则不论富、乏血与否直接判定为AVS型。门静脉供血型则为动脉期及实质期完全无瘤体染色,直接或回流性门静脉造影显示异常血窦充盈染色。分型确定后对Ⅰ～Ⅲ型患者行平阳霉素碘油乳剂(PLE)肝动脉栓塞。统计总体瘤体缩小率和各型瘤体缩小率并分析其差别。结果102例动脉造影全部成功。其中,富血型58例(56.8%),乏血型30例(29.4%),AVS型13例(12.7%),门静脉供血型1例(0.98%)。在AVS型患者中,肝动脉-门静脉分流11例,肝动脉-肝静脉分流2例。分流时相出现于动脉期10例,出现于实质期3例。总体瘤体缩小率为46.7%,富血型瘤体缩小率为56.3%,而乏血型为27.9%,AVS型46.6%。各型之间瘤体缩小率差异有统计学意义(P<0.05),而富血型和AVS型均较乏血型为高,差异有统计学意义(P<0.05),但富血型和AVS型之间差异无统计学意义(P>0.05)。结论根据肝动脉造影表现可将CHL分为富血、乏血、AVS、门静脉供血四种类型。其中富血、乏血及AVS型之间行PLE肝动脉栓塞时瘤体缩小率有显著差别。此分型可作为选择疗法和估计瘤体缩小程度的依据。
Objective To investigate the classification and clinical significance of arteriovenous angiography in hepatomegalioma (CHL). Materials and Methods 102 cases of CHL patients, 35 males and 67 females, aged 23 to 70 years, mean 41.3 years. All patients underwent hepatic arteriography: the catheter was located at the level of the hepatic artery, and the contrast agent injection rate was 5ml / s. The DSA was continuously and completely collected for the arterial phase and the parenchymal phase. Arteriography was divided into 4 types according to the following criteria: blood type (type Ⅰ), blood type (type Ⅱ), arteriovenous shunt (AVS) type (type Ⅲ) and portal vein type (type Ⅳ). Various types of criteria: blood type of arterial light - moderate thickening, arterial abnormalities can be seen more sinusoidal development, substantial abnormal sinusoid filling most of the tumor area. Blood-deficient blood vessels without thickening, visible in the arterial phase of the small number of abnormal sinusoids in the tumor peripheral development, substantial abnormal sinusoid filling a small part of the tumor area. AVS appears regardless of the rich, lack of blood or directly determine the AVS type. The portal vein blood type was completely tumor-free at arterial and parenchymal stages, and direct or recurrent portal venous angiography showed abnormal sinusoidal filling. Typing was performed on patients with type Ⅰ ~ Ⅲ pingyangmycin lipiodol emulsion (PLE) hepatic artery embolization. Statistics of overall tumor shrinkage and various types of tumor shrinkage and analyze the difference. Results 102 cases of angiography were all successful. Of these, 58 (56.8%) were rich, 30 (29.4%) were poor, 13 (12.7%) were AVS and 1 (0.98%) were portal venous. In AVS patients, hepatic artery-portal shunt in 11 cases, hepatic artery - hepatic vein shunt in 2 cases. Shunt phase appeared in the arterial phase in 10 cases, occurred in 3 cases of puberty. Overall tumor shrinkage rate was 46.7%, rich type tumor shrinkage was 56.3%, while the lack of blood type was 27.9%, AVS 46.6%. There was a significant difference in the rate of tumor shrinkage between the two groups (P <0.05), while both the rich and the AVS types were higher than those without the blood type (P <0.05) There was no significant difference between the two groups (P> 0.05). Conclusion According to the performance of hepatic arteriography CHL can be divided into four types: blood enrichment, blood deficiency, AVS, portal vein blood supply. Among them, there was a significant difference in the rate of tumor shrinkage between PLE and arterial embolism in blood-rich, blood-deficient and AVS-type. This classification can be used as a choice of therapy and to estimate the extent of tumor basis.