膈下动脉栓塞介入治疗肝肿瘤的价值

Hepatic Neoplasms with Blood Supply from Inferior Phrenic Arteries:Its Significance in TACE

目的:评价经导管做膈下动脉(IPA)栓塞化疗的安全性和效果。材料和方法:对370例经血管造影确认有IPA参与肝肿瘤供血者进行了487例次经导管动脉内化疗栓塞术(TACE)。结果:肿瘤接近肝脏表面229例,其中位于右叶裸区(S7)137例。栓塞IPA的技术成功率为100%,异常造影表现IPA主干及前后分支管径增粗、肿瘤染色(100%)、非肿瘤性染色(29.7%)、IPA与其他动脉形成交通支(33.5%)和IPA-静脉瘘(10.8%)。肝肿瘤完全被碘油充填占94.6%,血AFP下降至正常范围占82.4%。术中主要并发症是肩区疼痛(96.5%)。结论:膈下动脉是供养肝肿瘤的重要侧支血管,对参与肿瘤供血的IPA进行化疗栓塞是一安全、有效的方法。

Purpose：To evaluate the efficacy and safety of transcatheter arterial chemoembolization（TACE）via IPA.Materials and Methods：370 cases of hepatic tumor fed by the IPA underwent a total of 487 procedures of TACE of the IPA.Results：The tumor was located near the liver surface in 229 of the 250 cases.137 cases of these tumors were located in segments 7.The technical success of TACE of the IPA was achieved in all cases.The abnormal findings on arteriography were enlarged of the IPA with tumor staining in all cases,non-tumor staining in 114（29.7%）,artery-to-artery anastomosis in 124（33.5 %）,arteriovenous shunts in 40（10.8 %）.The tumor was completely filled with lipiodol on the follow-up CT in 94.6 %,associated with reduction of AFP significantly in 82.4 %.The major complication in the procedure is pain of the shoulder 96.5 %.Conclusions：Collateral branches originated from inferior phrenic artery are important feeding vessels for liver cancer.TACE of the IPA is a safe and effective method in the management of hepatic neoplasms supplied by IPA.