内乳动脉参与肝癌供血的介入治疗

Treating hepatic carcinoma with internal mammary artery blood supply through transcatheter arterial chemoembolization

目的探讨内乳动脉(IMA)对肝癌的供血及其介入栓塞在肝癌治疗中的价值。评价经导管作IMA栓塞化疗的安全性和效果。方法对86例经血管造影确认有IMA参与肝癌供血患者进行TACE。全部病例均曾行TACE治疗,16例曾行经皮微波固化治疗,4例有外科手术史。术前行CT或MRI平扫及增强扫描,术中行IMA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,然后注入明胶海绵碎粒或PVA颗粒,并摄肝区平片,观察肝区碘油分布及术后临床经过、相关实验室检查和影像学表现,并与血管造影进行对照分析。结果本组病例病灶均为巨块型,均位于肝脏前部接近膈肌或(和)肝包膜。57例累及S4、S5、S8段,29例累及S5、S7、S8。80例为右侧IMA参与供血,5例为左侧IMA参与供血,1例为双侧IMA参与供血。86例参与供血的IMA栓塞全部成功。未出现皮肤损伤并发症。结论IMA参与肿瘤供血一般多见于过去曾多次行TACE的巨块型肝癌患者,且肿块位于肝前部。IMA TACE方法安全,技术可行,但应警惕皮肤损伤并发症。

Objective To study blood supply by the internal mammary artery （IMA）for hepatic carcinoma and evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE）via IMA. Methods 86 cases of hepatic cancer（HCC） fed by the IMA underwent TACE of the IMA. All of the patients had previously undergone several TACE for HCC. 16 patients had undertaken percutaneous microwave coagulation therapy in addition to TAE. 4 patients had a history of surgery for upper abdomen. Plain and enhanced CT and MRI scannings were performed before operation. Internal mammary arteriography was carried out during the interventional procedure to clarify the feeding range and then the superselected catheterization of the feeding branch was done with TACE. The IMA angiographic features, tumor location, clinical observation, laboratory tests, imageology were evaluated, and finally were correlated with the angiographic findings of the IMA. Results All lesions were massive type and located at the ventral aspect and subcapsular region of the liver： 57 cases in segment 4, 5, 8, and 29 cases in segment 5, 7, 8. Recurrent HCCs were supplied by the right IMA in 80 cases, from the left IMA in 5 cases and with the bilateral IMA in 1 case. Lipiodol-TACE of the IMA for HCC can be performed without skin complications in cases of subselective catheterization. Conclusion Tumors located ventrally and superficially in the liver may recruit blood supply through IMA collaterals, often occurring in massive type of HCC after several times of TACE. TACE of IMA is safe and has become technically feasible in almost all patients, although cutaneous damage should be cautious during the interventional procedure.