臺灣博碩士論文加值系統

本研究是利用超音波來量測總肝動脈(common hepatic artery）的血流波形，並使用影像處理技術來處理血流波形，且利用FFT技術分析其諧頻的正規化值。本實驗利用各諧頻值與RI、PI與S/D對於各項分類探討其對血液流動情形之影響。
實驗的對象分為肝腫瘤病人（實驗組，n=71，年齡為57.0±15.2，58M19F）與非肝腫瘤病人（控制組，n=28，年齡為58.0±15.2，11M17F）兩大類，而在肝腫瘤病人中，又將年齡、性別、肝硬化與否、門靜脈拴塞與否、αFP、腫瘤大小與ICG不同分為幾群，並以t-test統計方法來分析之。在實驗最後的結果中，我們發現控制組的第一諧頻較低(0.772±0.049 vs. 0.806±0.042，p<0.05)，RI則是比較大(0.781±0.026 vs. 0.688±0.040，p<0.001)，由RI的結果可以說明正常組織的阻抗比較大，也驗證了我們的理論。以門靜脈拴塞與否分類，我們得到門靜脈拴塞者的第一諧頻較高(0.842±0.043 vs. 0.413±0.058，p<0.05)，RI值則是比較小(0.653±0.098 vs. 0.715±0.058，p<0.05)，由RI的實驗結果與Platt等人的實驗結果相符合。以肝硬化與否分類，我們的到肝硬化者的第一諧頻較大(0.801±0.079 vs. 0.757±0.067，p<0.05)。若以αFP≦20與否為分類，我們得到αFP的第一諧頻比較小(0.756±0.089 vs. 0.812±0.076，p<0.05)。除了上述幾種分類有具體的統計意義之外，在性別與ICG方面則並沒有任何顯著的意義。
由我們的研究結果中，發現若單純由單變數比較結果來，在門靜脈拴塞、肝硬化以及αFP方面，諧頻會比RI有效；但是以多變數比較結果下，由multi-regression的結果中，我們發現RI比諧頻更有說服力。由於影響血液流體力學的因素有二：血壓與血流速，但是我們卻只有考慮血流波形的因素進去，並沒有考慮速度的絕對值與血壓波形，因此才會出現這樣的結果。

In this study，we measure the waveform of the blood velocity in common hepatic artery using Doppler ultrasound. Image processing and fast Fourier transform(FFT) were used to get peak velocity waveform of the normalized amplitude of individual harmonics. The harmonics of velocity waveform and RI etc. were investigated for the hemodynamics of hepatocellular carcinoma (HCC).
The subjects studied were divided control group and HCC group. The Hcc group studied were further categorized into varies groups based on theirs age，sex，portal vein thrombosis(PVT)，liver cirrhosis，α-fetoprotein(αFP)，iodocyanide green(ICG) after 15 minutes and ICG after 20 minutes in turns. Results showed that the first harmonic values in control group were lower than those in HCC group(0.772±0.049 vs. 0.806±0.042，P<0.05). RI values in control group were higher than those in HCC group(0.781±0.026 vs. 0.688±0.040，P<0.01). The second harmonic values decreased with age. The first harmonic values in non-PVT were smaller than that in PVT group(0.790±0.084 vs. 0.842±0.043，p<0.01). The RI values in non-PVT were larger than that in PVT group(0.413±0.058 vs. 0.653±0.098，p<0.01). The first harmonic values in liver cirrhosis group were higher than those in liver non-cirrhosis (0.801±0.079 vs. 0.757±0.067，p<0.05). The first harmonic values in αFP<20 group were smaller than those inαFP>20 group(0.756±0.089 vs. 0.812±0.076，p<0.05).
With single t-test statistics showed that velocity harmonics were better than RI，in the classifications of PVT，liver cirrhosis andαFP . However considering multi-variables statistics，RI was better in the classifications of PVT and tumor size.

目 錄
致謝……………………………………………………………….…………..I
中文摘要……………………………………………………………………..II
英文摘要…………………………………………………………………...IV
目錄…………………………………………………………………………V
表目錄……………………………………………………………………..VII
圖目錄……………………………………………………………………..VIII
第一章 緒 論…………………………………………………………..1
1 -1 前 言…………………………………………………………..1
1 —2 文獻回顧………………………………………………… 2
1 —3 研究動機及目的………………………………………….3
1 —4 論文架構………………………………………………….4
第二章 研究原理………………………………………………………………5
2 —1 超因波成像原理………………………………………..5
2 —2 肝臟的結構……………………………………………..8
2 —3 肝癌的簡介……………………………………………..9
2 —4 腫瘤血液流體力學…………………………………….11
2 —4 —1 腫瘤內部血管型態學…………………11
2 —4 —2 腫瘤血液流體力學各項參數………….12
2 —4 —3 諧頻與血液流體力學………………….14
第三章 實驗方法及設備……………………………………………...16
3 —1實驗設備介紹…………………………………………………………….. 16
3 —2 實驗對象與步驟………………………………………………..16
3-3 影像分析過程…………………..…………………………...17
3-3-1 血流流速頻譜分析………………………………………..18
3-3-2 統計方法…………………………………………………..18
第四章 實驗結果與討論
4-1 控制組與實驗(HCC)組之比較………………………………..20
4-2 年齡隊各項參數之影響……...………………………………..21
4-3 性別隊各項參數之影響……...………………………………..21
4-4 門靜脈拴塞與否對參數之影響……………………………….22
4-5 肝硬化隊各項參數之影響…………………………………….23
4-6 αFP大小對各項參數之影響…………………………………24
4-7 腫瘤大小對各參數之影響…………………………………….24
4-8 ICG對各參數之影響………………………………………….25
4-9 其他實驗結果………………………………………………….26
第五章 結論與未來展望……………………………………………….27
5-1 結論……………………………………………………………...27
5-2 未來展望………………………………………………………...28
參考文獻………………………………………………………………..30
附錄A、表格…………………………………………………………..34
附錄B、圖形……...……………………………………………………46
附錄C、肝癌的治療方法……………………………………

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