左膈下动脉供血在肝癌介入治疗中的价值

Hepatocelluar carcinoma with blood supply from left inferior phrenic arteries:its significance in TACE

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。评价经导管做LIPA栓塞化疗的安全性和效果。方法对22例经血管造影确认有LIPA参与肝癌供血者进行动脉栓塞化疗(TACE)。结节型20例,巨块型2例。术前行CT或MRI平扫及增强扫描,术中常规做腹腔动脉-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,然后注入明胶海绵碎粒或PVA颗粒。观察术后临床经过、相关实验室检查和影像学表现,并与血管造影进行对照分析。结果病灶位于肝左叶18例(81·8%):7例位于S3,7例位于S2,4例位于S4。病灶位于肝右叶(S5)4例(18·2%)。22例患者左膈下动脉TACE全部成功。9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的病人并且肿块位于肝左叶。栓塞左膈下动脉的安全性很高,并发症少且多为自限性。

Objective To investigate the blood supply by the left inferior phrenic artery （LIPA） to hepatocelluar carcinoma （HCC） and to evaluate the efficacy and safety of transcatheter arterial chemoembolization（TACE） via LIPA. Meth- otis Twenty-two patients with HCC fed by the LIPA underwent TACE of the LIPA. Twenty patients were with nodular-type HCC, and two patients with massive-type HCC. For treatment, enhanced CT and/or MRI scanning and celiac-hepatic and inferior phrenic arterial arteriography were performed to assess the arterial blood supply to the tumor, then selected catheterization and chemoembolization was achieved followed by embolization with polyvinyl alcohol particles. The LIPA angiographic features, tumor location, clinical observation, laboratory tests, imageology were monitored and analyzed. Resuits The tumor was located in the left lobe of the liver in 18 patients （81.8% ） ： seven in segment 3, seven in segment 2, and four in segment 4. The tumor was located in the right lobe of the liver in four patients （ 18.2% ） which were all in segment 5. Transarterial chemoembolizati.on＂ was technically successful in all patients. The hepatic artery was completely blocked in eight patients. Two patients developed basilar atelectasis of the left lung and pleural effusion without clinical sequelae. Conclusion HCC with blood supply from LIPA mainly occur in the patients whose tumor located on the left lobe of the liver and/or who have previously undergone multiple TACE. TACE via LIPA is a potentially safe and effective treatment option for these HCC patients with LIPA collateral vessels.