肝外侧支动脉参与肝癌供血的介入治疗

Extrahepatic collateral arteries are involved in the blood supply to hepatocellular carcinoma： angiographic demonstration and transcatheter arterial chemoembolization

目的 探讨肝外侧支动脉对肝癌供血的规律及其临床意义。方法2006年8月至2010年8月间，874例存在肝外侧支动脉供血的肝细胞癌（HCC）患者行经导管动脉化疗栓塞术（TACE）1356例次，对具体血管途径、例次、栓塞成功率以及并发症类型、发生率进行回顾性分析。结果右膈下动脉、左膈下动脉、右内乳动脉、左内乳动脉、右肋间动脉、网膜动脉、结肠动脉、胆囊动脉、胃左动脉、胃右动脉以及右肾包膜动脉、右肾上腺下动脉和右肾上腺中动脉的TACE发生率分别为76．3％、2．4％、6．9％、0．4％、2．9％、2．0％、0．8％、2．3％、1．3％、1．1％和3．5％，TACE成功率分别为95．9％、93．8％、100．0％、100．0％、55．0％、77．8％、63．6％、67．7％、76．5％、73．3％和95．8％。5．6％的右膈下动脉供血病灶位于肝脏深部，其余所有肝外侧支动脉供血病灶均累及或者接近肝脏表面。96．0％的患者有TACE治疗史。TACE并发症包括肩胛或后背区疼痛、酸胀、皮肤坏死、胆囊炎、下肺叶盘状肺不张、少量胸腔积液和呃逆等。结论经肝外侧支动脉行TACE，技术上安全可行。

Objective To evaluate the incidence of extrahepatic collateral arteries involved in the blood supply to hepatocellular carcinoma （HCC） and to assess the technical success rates and complications of transcatheter arterial chemoembolization （TACE） through the collaterals. Methods 1356 TACE procedures were performed in 874 consecutive patients through extrahepatie collateral pathways to HCC between August 2006 and August 2010 in our department. The extrahepatic collateral pathways to HCC revealed on angiography were retrospectively evaluated. TACE through extrahepatic collaterals using iodized oil and gelatin sponge particles was performed when a catheter was advanced into the feeding branch to avoid nontarget embolization. Results Incidences of collateral source to HCC were 76.3% from the fight inferior phrenic artery （R1PA）, 2.4% from the left inferior phrenie artery （LIPA）, 6.9% from the right and 0.4% from the left internal mammary arteries （RIMA, LIMA）, 2.9% from the fight intercostal artery （RICA）, 2.0% from the omental artery, 0.8% from the fight or middle colic artery, 2.3% from the cystic artery, 1.3% from the left and 1.1% from the fight gastric arteries （LGA, RGA）, 3.5% from the fight renal capsular artery （ RRCA ）, fight middle adrenal artery （RMAA） and fight inferior adrenal artery （ IAA ）. Technical success rates of TACE were 95.9% in the RIPA, 93.8% in the LIPA, 100.0% in the RIMA and LIMA, 55.0% in the RICA, 77.8% in the omental artery, 63.6% in the colic artery, 67.7% in the cystic artery, 76. 5% in the LGA, 73. 3% in the RGA and 95. 8% in the RRCA, RMAA, and RIAA. Complications included skin erythema and necrosis after TACE through the RIMA, skin erythema after TACE through the RICA, eholecystitis after TACE through the cystic artery （ n =1 ） , and pleural effusion, basal atelectasis and hiccup after TACE through the IPA. Conclusion TACE through extrahepatic collaterals is safe and feasible, and with a high success rate in the treatment of hepatocellular carcinoma.