原发性肝癌右膈下动脉的栓塞治疗

Interventional treatment of primary liver cancer with inferior phrenic artery chemoembolization

目的探讨在原发性肝癌(PLC)右膈下动脉供血介入治疗(TACE)中的临床价值。方法回顾分析右膈下动脉(RIPA)参与供血的36例PLC患者的介入治疗资料。所有患者均行RIPA造影,观察RIPA的解剖及供血情况,对参与供血的RIPA行超选择性TACE治疗。结果 36例中RIPA起自腹主动脉前壁17例;起自腹腔动脉开口处9例;起自右肾动脉开口处4例;起自右肾动脉主干6例。RIPA供血PLC表现为病灶对比剂染色淡薄或残缺不全有17例(47.2%);表现为碘油沉积有缺损者有10例(27.8%);表现为肝动脉狭窄、变细或闭塞有6例(16.7%);表现为巨大肿瘤位于右膈下有23例(63.9%);表现为术后AFP不降甚至升高有21例(58.3%)。结论在PLC治疗过程中,重视寻找和栓塞参与PLC供血的RIPA,对提高右膈下动脉供血介入治疗疗效具有重要的临床意义。

Objective To investigate the value of interventional treatment of primary liver cancer（PLC） with inferior phrenic artery chemoembolization（TACE）.Characteristics of supplying the primary liver cancer and the clinical significance of the right inferior phrenic artery （RIPA） chemoembolization for the treatment of tumor.Methods The data of 36 PLC patients underwent RIPA （feeding the tumor） chemoembolization were retrospectively analyzed.RIPA angiography was performed.The tumor size,location and staining were reviewed.Results The RIPA was originated from the anterior wall of the abdominal aorta in 17 cases,from the orifice of celiac axis in 9 cases,from the orifice of the right renal artery in 4 cases,and from the trunk of the right renal artery in 6 cases.RIPA supplying PLC presented with incomplete staining of tumor in 17 cases（47.2%）,insufficient lipiodol deposition in 10 cases（27.8%）,narrowing or occlusion of common hepatic artery in 6 cases（16.7%）,massive tumor under right phrenic in 23 cases（63.9%）,and elevation of AFP after TACE in 21 cases（58.3%）.Conclusion The efforts of finding and taking RIPA chemoembolization should be made for increasing the therapeutic efficacy of PLC.