程序性造影在原发性肝癌介入栓塞治疗中的应用价值

Evaluation of protocolized angiography in performing the interventional procedure for hepatocellular carcinoma

目的研究治疗原发性肝癌中,程序性肠系膜上动脉、腹腔动脉及肝总动脉造影在TACE发现肝癌非常规供血动脉的作用及其临床意义。方法回顾分析2005年1月至2009年12月,所有在南京医科大学附属第一医院放射科首次行TACE治疗的原发性肝癌患者的血管造影资料及介入手术治疗报告。根据造影程序将其分为两组:A组526例患者常规行肠系膜上动脉、腹腔动脉及肝总动脉造影,B组850例只行肝总动脉的造影,均在明确病灶的供血动脉后进行TACE治疗。两组患者动脉造影时均在肿瘤染色不佳或无染色时寻找异位肝癌供血动脉,对肿瘤的供血动脉为腹腔干-肝总动脉之外的血管分别根据其起源进行分类及统计,并就两组的发现率进行统计学分析,比较发现率的高低并分析产生此统计学差异的原因。结果两组肝癌的肠系膜上动脉分支供血的发现率为A组14.1%(74/526)、B组8.9%(76/850);胃左动脉分支供血的发现率为A组6.7%(35/526)、B组3.3%(28/850);膈动脉供血的发现率分别为A组4.6%(24/526)、B组2.6%(22/850);腹腔干供血的发现率分别为0.5%(3/526)、0(0/850)。此4组侧支血管的发现率A组均高于B组(P<0.05)。而对于胃十二指肠动脉、右肾动脉、肋间动脉、胸廓内动脉及脾动脉的肝癌异常供血的发现率2组差异无统计学意义(P>0.05)。结论程序性造影可以提高肝癌侧支供血动脉的发现率,特别是提高副肝动脉对肝癌供血的发现率,在提高肝癌的早期完全栓塞率,控制肿瘤的复发中有一定的意义。

Objective To assess the clinical value of protocolized angiography,including the superior mesenteric artery（SMA）,the celiac artery and the common hepatic artery angiography,in detecting the atypical tumor feeding arteries of hepatocellular carcinoma（HCC） during transarterial chemoembolization（TACE） procedure.Methods The clinical data of all patients who received the initial TACE for HCC during the period of January 2005-December 2009 were collected and were retrospectively analyzed.Both the angiograms and procedure reports were reviewed.According to the angiography protocols used in interventional procedure the patients were divided into two groups.Group A included 526 patients who received the protocolized angiography,including the SMA,the celiac artery and the common hepatic artery,while Group B composed of 850 patients who underwent the routine angiography of the common hepatic artery.For all patients in both groups the atypical tumor feeding arteries were searched for when the tumor staining was incomplete.The anatomic variations of tumor feeding arteries were classified and were statistically analyzed.Results The detection rate of tumor supply from the branches of SMA,left gastric artery,phrenic artery and celiac artery was 14.1%,6.7%,4.6% and 0.5% respectively in group A,while it was 8.9%,3.3%,2.6% and 0% respectively in group B.Significant difference in all above four detection rates existed between two groups（P 0.05）.The difference in detection rate of tumor feeders from the gastroduodenal artery,the right renal artery,the intercostals artery,the internal mammary artery and the splenic artery showed no statistical significance between two groups（P 0.05）.Conclusion Compared with the conventional common hepatic arteriography during TACE,the diagnostic protocolized angiography,including the SMA,the celiac artery and the common hepatic artery,can markedly improve the detection rates of atypical tumor feeders of HCC,such as the accessory hepatic artery,which means that the tumor will be occluded more completely and be controlled more promptly.