原发性肝癌胃左动脉分支供血的相关因素分析

Left gastric artery participating in the blood supply of the primary liver cancer:an analysis of the related factors

目的探讨程序性肠系膜上动脉、腹腔动脉及肝总动脉造影在发现原发性肝癌(PLC)胃左动脉(LGA)分支供血中的作用;总结PLC LGA分支供血的一般规律,提高PLCLGA分支供血的发现率。方法回顾分析2005年01月至2009年12月我院首次介入治疗中患者的血管造影资料。依据造影模式分为两组,A组作程序性肠系膜上动脉、腹腔动脉及肝总动脉造影(526例);B组则直接肝总动脉造影(850例)。将LGA供血分支进一步分为替代肝左动脉、副肝左动脉及寄生供血,并就其发现率进行统计分析。对LGA分支供血的病例就肿瘤部位、肿瘤大小、肿瘤染色及碘油沉积情况比较分析。结果 A组42例作选择性LGA造影,其中36例见PLC有LGA供血:B组82例作选择性LGA造影,其中39例发现LGA供血,A、B两组LGA供血阳性率分别为85%(36/42)和48%(39/82),两组间差异有统计学意义(p=0.001)。A组36例LGA供血中,副肝左动脉10例,B组39例LGA供血中,4例为副肝左动脉,A组和B组副肝左动脉的发现率分别为1.9%(10/526)和0.5%(4/850),差异有统计学意义(P=0.022)。而替代LGA及LGA寄生性供血两组差异无统计学意义。两组共75例LGA供血的病例中,肿瘤单纯位于肝左叶的61例,14例侵犯肝左右叶;75例中LGA增粗70例(93%),病灶肝总动脉造影染色不全者62例(83%,62/75);常规肝动脉栓塞碘油沉积缺损者54例(72%,54/75)。结论程序性造影能提高LGA造影的阳性率,特别是副肝左动脉肿瘤供血的发现率。对于侵犯肝左叶、程序性造影LGA增粗、常规肝动脉造影及栓塞中肿瘤染色不全或碘油沉积欠佳时,须行超选择性LGA造影,以提高LGA分支供血肿瘤的发现率。

Objective To discuss the characteristics of the left gastric artery （LGA） involved in the blood supply of the primary liver cancer （PLC）. Methods During the period from Jan. 2005 to Dec. 2009, a total of 1376 patients with PLC were admitted to authors＇ hospital to receive initial transcatheter arterial chemoembolization （TACE）. The angiographic findings were retrospectively analyzed. Based on the angiographic protocols the patients were divided into group A （n = 526） and group B （n = 850）. Programmed angiography of the superior mesenteric artery （SMA）, the celiac artery and the common hepatic artery was employed in patients of group A, while routine angiography of the common hepatic artery was carried out in patients of group B. The aberrant hepatic arteries and extra-hepatic collateral arteries that fed the tumors were carefully searched for when the tumor staining was incomplete in all the patients of the both groups. The LGA and its branches, which acted as the tumor feeding vessels in PLC patients, were identified as the substitutes of the left hepatic artery, accessory hepatic artery and tumor parasitic feeder. The positive rates of LGA as a tumor feeder of the two groups were calculated. The tumor location, tumor staining and lipiodol deposition in the patients whose LGA supplied the tumors were also determined and analyzed. Results Forty-two patients in group A and eight-two cases in group B received LGA angiography. The positive rate of LGA as the tumor feeder was 86% （36/42） in Group A and was 39% （39/82） in Group B. The difference between the two groups was statistically significant （P 〈 0.05）. The detection rate of accessory left hepatic artery from the LGA was 1.9% （10/526） in group A and was 0.5% （4/850） in group B. Statistically significant difference in the detection rate of the accessory left hepatic artery from LGA existed between the two groups （P 〈 0.05）. A total of 75 cases whose tumors had blood supply from LGA were found in the two groups. The tumors were found to be located only in the left hepatic lobe in 61 patients, and to be located in both lobes in 14 cases. No tumor that was located only in the right hepatic lobe was seen. Dilated LGA was found in 70 cases （93%）. Incomplete tumor staining occurred in 83% of cases （62/75）. Incomplete lipiodol deposition after intra-hepatic artery chemoembolization occurred in 72% of cases （54/75）. Conclusion The diagnostic programmed angiography is more sensitive in detecting the LGA that is supplying tumors. Super-selective LGA angiography is needed when LGA is dilated, or tumor staining and lipiodol deposition are incomplete, or the left hepatic lobe is involved, in this way the detection rate of LGA supply can be improved. （J Intervent Radiol, 2012, 21： 473-477）