肝动脉闭塞后通过侧枝血管行经导管动脉化疗栓塞的疗效研究

The value of extrahepatic collateral arteries chemoembolization for hepatocellular carcinoma(HCC) because of proximal hepatic artery occlusion

目的探讨原发性肝癌多次经导管肝动脉化疗栓塞(transactheter arterial chemoembolization,TACE)术后造成肝动脉闭塞后,通过侧枝血管途径再次行TACE的可行性及疗效观察。方法回顾性分析38例原发性肝癌患者多次TACE术后导致肝动脉闭塞DSA检查结果,并经侧枝血管途径对肝内病灶进行TACE或经导管肝动脉化疗灌注(transcatheter arterial infusion,TAI),分析其可行性及疗效。结果 38例患者均为多次TACE术后。DSA造影发现肝动脉闭塞,均通过肝外侧枝循环供血,共发现43条肝外侧支血管。成功超选进入靶血管31条(72.1%),未成功超选为12条(27.9%)。2个月后评价疗效。成功超选进入全部靶血管并进行肿瘤供血动脉栓塞共27例(71.1%),总有效率为25.9%(7/27),临床获益率为77.8%(21/27)。未能成功超选靶血管11例(28.9%),仅行TAI,总有效率为9.1%(1/11),临床获益率为36.4%(4/11)。结论原发性肝癌多次行TACE术后可造成肝动脉闭塞,经侧枝血管途径可再次行TACE,疗效较TAI显著。

Objective To discuss the clinical feasibility and value of super selective chemoembolization of extrahepatic collateral arteries in the treatment of HCC which proximal hepatic artery is occluded after repeated transactheter arterial chemoembolizations（TACE）.Methods To analyze retrospectively the DSA manifestations of 38 cases which were treated with repeated TACE technique.And we evaluated the feasibility and therapeutic effect of super selective chemoembolization of extrahepatic collateral arteries.Results All 38 cases were treated with TACE more than 2 times.Hepatic artery occlusion and 43 extrahepatic collateral arteries were found.Extrahepatic collateral arteries were included：superior mesenteric artery（SMA） branches in 15 cases（34.9%）,left gastric artery branches in 13 cases（30.2%）,gastroduodenal artery（GDA） branches in 7 cases（16.3%）,internal mammary artery 2 cases（4.7%）,pancreaticoduodenal artery（PDA）arch branches in 2 cases（4.7%）,subphrenic artery in 1 case（2.3%）,right lumbar artery in 1 case（2.3%）,right adrenal artery in 1 case（2.3%）,right colic artery in 1 case（2.3%）.The successful rate of super selective catheterization of extrahepatic collateral arteries was 72.1%,and the failure rate was 27.9%.The effect had been evaluated after 2 mouths.Super selective chemoembolization of extrahepatic collateral arteries was 27 cases（71.1%）.Of 27 patients,none obtained CR（0%）,7 cases PR（25.9%）,14 cases SD（51.9%）,and 6 cases were PD（22.2%）,with a total efficiency of 25.9% and the clinical benefit rate of 77.8%.And the other 11 cases were only treated with TAI.None patient obtained CR（0%）,1 Cases PR（9.1%）,3 cases SD（27.3%）,and 7 cases were PD（63.6%）,with a total efficiency of 9.1% and the clinical benefit rate of 36.4%.Conclusions Repeated TACE can lead to extrahepatic collateral arteries in patients with HCC.Super selective chemoembolization of extrahepatic collateral arteries can improve the therapeutic effect of TACE for HCC.