肝癌肝外动脉供血的形成机制与介入治疗的研究

A study on extrahepatic arterial blood supply of liver cancer and its influence on interventional therapy

目的研究肝癌肝外动脉供血的形成机制 ,旨在指导介入治疗。方法 10 38例肝癌经动脉化疗栓塞 (TACE)前常规腹腔动脉和肠系膜上动脉造影 ,对癌灶临近膈肌的 10 2例加作选择性膈下动脉造影 ,分析肝癌肝外动脉供血特征。结果 14 7例肝外动脉供血来源于膈下及右肾上腺动脉 5 4例 (36 7% ) ,胃十二指肠及网膜动脉 5 0例 (34 0 % ) ,胃左动脉 2 2例 (15 0 % ) ,胰十二指肠动脉弓 18例 (12 2 % ) ,结肠右动脉 3例 (2 1% )。其中 ,97例为肝癌本身固有的寄生性供血(6 6 0 % ) ,37例为TACE后肝动脉闭塞所致的肝外侧枝循环 (2 5 2 % ) ,其余为肝切缘网膜粘附供血(8 8% )。肝外动脉供血与癌灶的部位和大小密切相关 ,肝外供血支的插管成功率为 82 3%。结论明确肝癌肝外动脉供血的形成机制对临床准确和彻底阻断肝癌多动脉供血 ,提高肝癌介入治疗的效果具有重要的意义。

Objective To study the mechanisms of extrahepatic arterial blood supply of liver cancer for its interventional therapy. MethodsRoutine celiac and superior mesenteric arteriography before transarterial chemoembolization (TACE) were performed in 1038 patients with liver cancer. In 102 patients with tumors near diaphragma,selective inferior phrenic arteriography was undertaken. The profiles of extrahepatic arterial blood supply of liver cancer were analyzed. ResultsOf 147 patients,the extrahepatic arterial blood supply from the inferior phrenic and right suprarenal arteries to the liver cancer was found in 54 cases (36.7%),and from the gastroduodenal and epiploic arteries in 50 cases (34.0%),left gastric artery in 22 cases (15.0%),pancreaticoduodenal arcade in 18 cases (12.2%),right colic artery in 3 cases (2.1%). Among them,97 cases had parasitic blood supply (66.0%),37 cases had extrahepatic collateral arteries because of proximal hepatic artery occlusion (25.2%) as a result of TACE,and the others had epiploic arteries at the resection edge of the liver (8.8%). The extrahepatic arterial blood supply was significantly correlated to diameter and location of the tumor. The successful rate of super selective catheterization of extrahepatic arteries was 82.3%. ConclusionsIt is important to determine the existence of extrahepatic arterial blood supply in liver cancer cases undergoing TACE in an attempt to improve the result of interventional therapy.