左侧膈下动脉参与肝癌供血的介入治疗研究

Blood Supply to Hepatocelluar Carcinoma Via the Left Inferior Phrenic Artery:Treatment with Transcatheter Arterial Chemoembolization

目的探讨左膈下动脉(LIPA)对肝癌的供血及其介入性栓塞在肝癌治疗中的价值。评价经导管行LIPA栓塞化疗的安全性和效果。资料与方法对16例经DSA确认有LIPA参与肝癌供血者进行肝动脉栓塞化疗术(TACE)。其中,结节型15例,巨块型1例。术前行CT或MRI平扫及增强扫描,术中常规行腹腔动脉、肝动脉及膈下动脉造影,在确认供血范围后将导管超选择至供血支,先用碘油-抗癌乳剂栓塞肿瘤末梢血管,然后注入明胶海绵颗粒或聚乙烯醇(PVA)颗粒。观察术后临床经过、相关实验室检查和影像学表现,并与DSA进行对照分析。结果病灶位于肝左叶13例(81.2%):5例位于S3,5例位于S2,3例位于S4。病灶位于肝右叶(S5)3例(18.8%)。16例患者LIPATACE全部成功。8例进行LIPA化疗栓塞时发现肝动脉完全阻塞。2例术后发生左下肺叶盘状肺不张和少量胸腔积液。结论LIPA参与肝癌供血多见于多次行TACE的患者并且肿块位于肝左叶。栓塞LIPA的安全性很高,并发症少且多为自限性。

Objective To investigate the blood supply of hepatocelluar carcinoma （HCC） by the left inferior phrenic artery（LIPA） and evaluate the efficacy and safety of transcatbeter arterial chemoembolization（TACE） via LIPA. Materials and Methods 16 cases of HCC fed by the LIPA underwent TACE of the LIPA. Nodular type was in 15 cases and massive type in 1 case. Enhanced CT and/or MRI scanning were performed before TACE. Celiac-hepatic and IPAs arteriography were performed during the interventional procedure. After identified the blood supply to the tumor, selected catheterization and chemoembolization were done. The LIPA angiographic features, tumor location, clinical observation, laboratory tests and imaging findings were evaluated before and after interventional procedure. Results The tumor was located in the left lobe of the liver in 13 cases （ 81.2% ） , including 5 cases in segment 3, 5 cases in segment 2, and 3 cases in segment 4. The tumor of 3 cases was located in the right lobe of the liver in segment 5 （ 18.8% ）. The hepatic artery was total blocked in 8 patients. 2 patients developed basilar atelectases of the left lung and pleural effusion without clinical sequelae. Conclusion LIPA collateral supply to HCC exists in HCCs located on the left lobe of the liver and in patients who have undergone multiple TACE procedures in the past. These LIPA collateral vessels can be embolized safely and effectively with less complications.