肝癌动脉血供变异在介入治疗中的意义

The significance of anomalous arterial blood supply of liver cancer in interventional therapy

目的:探讨肝癌动脉血供变异在经动脉导管化疗栓塞术中的临床意义。方法:前瞻性研究分析我院2006年全年共220例(330次)肝癌动脉血管造影及介入治疗资料。结果:220例中171例(77.7%)为典型腹腔动脉-肝总动脉供血。肝动脉解剖变异29例(13.2%,29/220),其中肝总动脉变异2例,肝右动脉变异23例,变异的肝右动脉或副肝右动脉有22例起源于肠系膜上动脉(75.9%,22/29),肝左动脉变异2例,肝左动脉和肝右动脉同时变异2例。20例(9.1%,20/220)在初次或重复介入治疗中发现存在寄生性供血动脉,其中起源于右膈下动脉10例,肠系膜上动脉、胃左动脉、网膜动脉及脾动脉各2例,左膈下动脉及右肋间动脉各1例。肝外侧支供血动脉的存在与病灶大小、位置及介入治疗次数之间显著相关。结论:认识肝癌动脉血供变异有助于提高经动脉导管栓塞成功率及介入治疗疗效。

Objective：To evaluate the incidence of anomalous arterial blood supply of liver cancer and to assess the clinical signifieance in intervenfional therapy. Methods： We prospectively evaluated the hepatic angiographie images of liver cancer and its clinical data in 220 cases （in 330 procedures） in our hospital in 2006. Results： 171 cases （77.7 % ） had the standard hepatic arterial anatomy. Variant hepatic arteries were found in 29 cases （13.2% ,29/220）, 2 cases had a variant origin of the common hepatic artery, 23 cases had variant right hepatic arteries （75.9% ,22/29 originated from mesenteric superior artery）, 2 case had variant left hepatic arteries, 2 cases had a variant anatomy involving both the left and the right hepatic arteries. 20 cases （9.1% ,20/220） had collateral were was revealed in 330 TACE procedures. Incidences of collateral source to liver cancer were 10 cases from the right inferior phrenic artery, 2 cases from mesenteric superior artery, the left gastric artery, the omental artery and the splenic artery respectively, 1 case from the left inferior phrenic artery and the right intercostal artery respectively. The presence of extrahepatic collateral arteries （ExCAs） is obviously associated with tumor size, location and multiple chemoembolizafion. Conclusion：The evaluation of the hepatic arterial anatomy and its variations on angiographic is important, which can improve the success rates and the therapeutic effect of the liver cancer.