膈下动脉参与肝肿瘤供血的介入治疗研究

Hepatic Neoplasms with Blood Supply from Inferior Phrenic Arteries:Treatment with Transcatheter Arterial Chemoembolization

目的 评价经导管做膈下动脉 (IPA)栓塞化疗的安全性和效果。方法 对 14 8例IPA参与肝肿瘤供血患者进行了 196例次TACE ,其中主要栓塞IPA占 11.5 %。做肝恶性肿瘤TACE时先用碘油 抗癌乳剂栓塞肿瘤末梢血管 ,然后注入明胶海绵碎粒。观察内容有既往治疗史、IPA参与肿瘤供血的表现、肿瘤部位、治疗效果及并发症。结果 首次接受TACE者 2 2例 ( 14 .9% ) ,既往曾做多次TACE者 87例 ( 5 8.8% ) ,曾接受其他治疗 (超声波引导下经皮肝穿刺治疗、肝脏外科手术 )者占 2 6.3 %。肿瘤位于接近肝脏表面者占 91.9% ,其中位于第 7段者占 5 4.7%。栓塞IPA的技术成功率为10 0 % ,异常造影表现有IPA管径增粗、肿瘤染色 ( 10 0 % )、非肿瘤性染色 ( 43 .2 % )、IPA与其他动脉形成交通支 ( 3 7.8% )和IPA 静脉瘘 ( 10 .8% )。治疗后复查CT显示肝肿瘤完全被碘油充填者占 94.6% ,血AFP下降至正常范围占 82 .7%。与栓塞IPA相关的并发症发生率为 8.1%。结论 任何位于接近肝脏表面的肿瘤都可能接受IPA供血。对参与肿瘤供血的IPA进行化疗栓塞是一安全、有效的方法。

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) via the inferior phrenic artery (IPA).Methods 148 cases of hepatic tumor fed by the IPA underwent a total of 196 procedures of TACE of the IPA, among them 11.5% case mainly underwent TACE of IPA?TACE of the malignancy was performed with an emulsion of iodized oil and anti-cancer agents,followed by gelatin sponge particle injection.The IPA angiographic features,tumor location,history of prior treatment,follow-up CT,and complications of TACE of the IPA were evaluated.Results The tumor supplied by IPA was noted at initial TACE in 22 (14.9%),at successive TACE in 87 (58.8%),after multiple percutaneous tumor ablation guided by ultrasound in 24 (16.2%),and after hepatic surgery in 15 (10.1%) cases.The tumor was located near the liver surface in 136 (91.9%) of the 148 cases.54.7% of these tumors were located in segments 7.The technical success of TACE of the IPA was achieved in all cases.The abnormal findings on arteriography were enlarged of the IPA with tumor staining in all cases,non-tumor staining in 64 (43.2%),artery-to-artery anastomosis in 56(37.8%),arteriovenous shunts in 16(10.8%) cases.The tumor was completely filled with lipiodol on the follow-up CT in 94.6%,associated with reduction of AFP significantly in 82.7%.Minor complications related to the procedure occurred in 12 patients (8.1%).Conclusion Hepatic tumor located near the liver surface can be supplied by an IPA.TACE of the IPA is a safe adjunct to TACE of the hepatic artery in the management of hepatic neoplasms supplied by the IPA.