原发性肝癌的肝外动脉供血来源类型和形成因素

Influence factors and types of extrahepatic collateral arterial formation in unresectable hepatocellular carcinoma.

目的 分析手术不能切除的肝细胞肝癌(HCC) ,化疗栓塞前后形成肝外侧支动脉(ECAs)的来源类型和形成因素。方法 回顾性分析35例患者,手术不能切除的肝癌,形成39支肝外侧支动脉供血,接受化疗栓塞术前后的病史、肝脏的电子机算机断层扫描片(CT)和肝脏血管数字减影片(DSA) ,研究HCC的ECAs来源类型与肝癌在肝内的部位、肝癌的大小和接受化疗栓塞的次数之间的关系。结果 ECAs来源类型分别源于胸廓内动脉(5 .1 %)、右肋间动脉(7.7%)、胃左动脉(1 2 .8%)、右膈下动脉(38.5 %)、大网膜动脉(2 .6 %)、右肾上腺或肾包膜动脉(1 0 .3%)。形成ECAs的影响因素较多,包括化疗栓塞的次数、肿瘤在肝内的部位、肿瘤的直径和化疗栓塞方式。绝大多数ECAs形成于多次化疗性栓塞后:化疗栓塞3～4次后,容易出现肝外动脉供血(1 7.9%) ;5～6次后,出现的概率显著增加(5 6 .4 %)。肿瘤位于肝脏表浅部位容易形成ECAs(71 .8%) ,常为肝脏相邻部位:前、后及右腹壁、右膈顶和右肾。肿瘤的直径在5～1 0cm时(76 .9%)。结论 ECAs来源类型与肝癌的肝内部位有密切关系。ECAs的形成与肿瘤的多次化疗栓塞、肿瘤的大小和肿瘤在肝内的部位有显著关系。

Objective To analyze the influence factors and formation of extrahepatic collateral arteries (ECAs) in unresectable hepatic cellular carcinoma (HCC) before and after chemoembolization. Methods Before and after the interventional chemotherapy, detail histories of 35 patients with 39 ECAs of HCC and images including computerized tomogram scan (CT), digital subtraction angiography (DSA) were reviewed carefully to identify ECAs of HCC, ECAs arising from, and anatomic location of tumors in liver.Finally,all the above measurements including the relations of ECAs with times of chemoembolization, were analyzed. Results Extrahepatic collaterals of HCC originated from right internal thoracic artery (RITA,5.1%), right intercostal artery(RICA,7.7%), left gastric artery (LGA,12.8%), right inferior phrenic artery (RIPA,38.5%), omental artery(OTA ,2.6%), superior mesenteric artery(SMA,23.1%), and right adrenal and renal capsule artery(RARCA,10.3%).The influence factors of formation of ECAs of HCC included the times of repeated chemoembolization, the location of tumors in liver, the tumor size and the types of chemoembolization. ECAs in HCC appeared after 3-4 times of chemoembolization (17.9%), but a higher frequency of ECAs occurred after 5-6 times of chemoembolization (56.4%). ECAs appeared easily in peripheral areas (71.8%) of liver abutting to the anterior, posterior abdominal walls, the top of right diaphragm and right kidney. ECAs also occurred easily after complete obstruction of the main trunk arteries supplying HCCs or the branches of proper hepatic arteries. Conclusions The formation of ECAs in unresectable HCC is obviously correlated with multiple times of chemoembolization, tumor size, types of chemoembolization, anatomic location of tumors.