肝动脉造影及栓塞对肝癌并下腔静脉癌栓的诊疗价值

Significance of Hepatic Arteriography and Embolization for Treating Hepatocellular Carcinoma Complicated with Inferior Vena Cava Tumor Thrombosis

目的：探讨肝动脉造影及栓塞对肝癌合并下腔静脉癌栓的诊疗价值。方法：回顾性分析10例肝癌并下腔静脉癌栓的重复肝动脉造影和栓塞的影像学表现及介入治疗意义。结果：10例均在肝动脉造影及栓塞前后显示下腔静脉癌栓血管，8例在栓塞后1～3个月内造影显示下腔静脉癌栓的供应血管增多，癌栓增大，其中2例累及心房。2例下腔静脉癌栓血管不显影。栓塞后癌栓内均见碘油沉积，部分癌栓缩小。结论：原发性肝癌之下腔静脉癌栓由肝动脉主要供血，造影有较好的诊断价值。栓塞对癌栓有一定的治疗作用，不排除有促进癌栓生长的可能。治疗上宜采用综合治疗。

Objective：To evaluate the clinical significance of hepatic arteriography and embolization for treating hepatocellular carcinoma （HCC） complicated with inferior vena cava （IVC） tumor thrombosis. Methods： Series of hepatic arter iography and embolization of 10 cases of HCC complicated with IVC tumor thrombosis were retrospectively studied. Results： Vessels of the IVC tumor thrombi were demonstrated before and after hepatic arteriography and embolization in all the 10 cases. After embolization, feeding vessels of IVC tumor thrombi increased and the size of the tumor thrombi enlarged within 1-3 months in 8 cases （in 2 of the cases, tumor thrombi involved right auricle of the heart as well）. IVC tumor thrombus vessels were not seen in 2 cases. However, Lipiodol deposits within tumor thrombi were demonstrated in all cases and reduction of the tumor thrombi occurred in some of the cases after embolization. Conclusion.. Hepatic artery （HA） was the major feeding vessel of IVC tumor thrombi in HCC,thus,hepatic arteriography was pretty useful for diagnosis. Embolization was,in a considerable extent,an effective procedure for treating HCC complicated with IVC tumor thrombi, however, the probability of influence on the acceleration and stimulation of the tumor thrombus growth by embolization could not be excluded. So,a combined therapeutic project for cases of HCC complicated with IVC tumor thrombosis was advocated.