基于CBCT的三维重建技术用于TACE术治疗原发性肝癌患者对肿瘤供血动脉识别的价值*

doi:10.3969/j.issn.1672-5069.2022.04.027

摘要/Abstract

摘要： 目的探讨基于锥形束CT(CBCT)的三维重建技术用于在行肝动脉化疗栓塞术(TACE)治疗原发性肝癌(PLC)患者过程中对肿瘤供血动脉的识别价值。方法 2018年1月～2021年1月我院诊治的PLC患者103例,所有患者接受TACE术治疗,在TACE术前54例接受DSA检查,49例接受基于CBCT的三维重建技术检查,寻找肿瘤供血动脉。术后随访3个月。结果 CBCT三维重建组手术时间、辐射照射量和超选择插管成功率分别为(42.3±5.1)min、(209.4±27.6)mGy和93.9%,而DSA组分别为(35.2±3.0)min、(142.3±15.2)mGy和66.7%,差异显著(P＜0.05); CBCT三维重建组供血动脉识别达到诊断要求为100.0%,病灶检出为93.9%,碘油完全沉积为91.8%,均显著优于DSA组(分别为74.1%, 70.4%和72.2%,P＜0.05);术后3个月复查,CBCT三维重建组有效率和疾病控制率分别为83.7%和89.8%,显著高于DSA组的57.4%和68.5%(P＜0.05)。结论相对于DSA检查,在采取TACE术治疗PLC患者术前行基于CBCT的三维重建检查能更好地识别肿瘤供血动脉,从而获得更好的手术治疗效果,但基于CBCT的三维重建检查可能延长了手术时间,增大了辐射照射量,也需要考虑。

关键词: 原发性肝癌, 锥形束CT, 三维重建, 血管造影, 肝动脉化疗栓塞, 供血动脉, 治疗

Abstract: Objective The aim of this study was to investigate the clinical value of three-dimensional reconstruction based on cone-beam CT (CBCT) for the identification of supplying arteries in patients with primary liver cancer (PLC) underwent hepatic arterial chemoembolization (TACE) . Methods A total of 103 patients with PLC were encountered in our hospital between January 2018 and January 2021, and all patients with PLC underwent TACE. During TACE process, 54 patients received DSA examination and 49 patients received CBCT-based three-dimensional reconstruction examination to find blood-supplying arteries. All patients were followed-up for 3 months after TACE. Results The operative time, the amount of radiation, and the success rate of superselective intubation rate in patients underwent CBCT-bade 3D reconstruction were(42.3±5.1)min,(209.4±27.6)mGy and 93.9%, significantly different compared to (35.2±3.0)min, (142.3±15.2)mGy and 66.7% in patients underwent DSA check-up (P＜0.05); the identification of supplying arteries meeting the diagnostic requirements in CBCT-based 3D reconstruction was 100.0%, the detection of lesions was 93.9%, and the complete deposition of lipiopine was 91.8%, all significantly superior to 74.1%, 70.4% and 72.2% in patients underwent DSA (P＜0.05); at the end of three month after operation, the effective rate and disease control rate in patients underwent CBCT-based 3D reconstruction were 83.7% and 89.8%, both significantly higher than 57.4% and 68.5%(P＜0.05)in patients underwent DSA. Conclusion As compared with DSA examination during TACE, the CBCT-based three-dimensional reconstruction for identify tumor supplying blood arteries in patients with PLC could obtain better short-term outcomes, however, the implementation of CBCT-based three-dimensional reconstruction might also prolong the operative time and increase the radiation exposure, which should take into consideration in clinical practice.

Key words: Hepatoma, Cone beam CT, 3D reconstruction, Digital subtraction angiography, Transhepatic arterial chemoembolization, Blood supply arteries, Therapy

刘浩, 周菲菲, 孙好凯, 刘永刚. 基于CBCT的三维重建技术用于TACE术治疗原发性肝癌患者对肿瘤供血动脉识别的价值^*[J]. 实用肝脏病杂志, 2022, 25(4): 563-566.

Liu Hao, Zhou Feifei, Sun Haokai, et al. CBCT-based 3D reconstruction technique in the identification of blood supplying arteries during TACE operation for patients with primary liver cancer[J]. Journal of Practical Hepatology, 2022, 25(4): 563-566.

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基于CBCT的三维重建技术用于TACE术治疗原发性肝癌患者对肿瘤供血动脉识别的价值^*

CBCT-based 3D reconstruction technique in the identification of blood supplying arteries during TACE operation for patients with primary liver cancer

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