肝癌介入治疗中肝动脉狭窄闭塞及肝外侧支血管对肝癌供血的分析

Extrahepatic Tumor-feeding Collaterals after Hepatic Arterial Occlusion during Interventional Treatment of Hepatic Cancer

目的 探讨在肝癌介入治疗中肝动脉狭窄闭塞后肝外侧支血管的形成对肝癌介入治疗的意义。材料与方法 观察和统计 787例肝癌血管造影中见到的 3 7例肝动脉狭窄闭塞者肝外侧支血管的部位及其发生率。结果 右膈下动脉和胃左动脉是形成肝外侧支的主要血管 ,分别占 40 .5 %、2 9.7% ,而胰十二指肠下动脉、胃十二指肠动脉、肠系膜上动脉分别占 8%、5 .4%、8%。肝右叶 7、8段肿瘤侧支血供主要来自右膈下动脉 ,5、6段肿瘤主要来自胆总管周围动脉 ,肝左叶肿瘤侧支血供主要来自胃左动脉。引起肝动脉狭窄闭塞的主要原因为重复导管化疗和操作不当。结论 肝动脉狭窄闭塞后肝外侧支血管成为肝肿瘤的主要供血动脉。了解侧支血管发生的部位及其发生率对肝癌患者的进一步治疗有重要意义。

Objective To study the extrahepatic collaterals after the occlusion of hepatic artery during interventional therapy for hepatic cancer.Materials and Methods Of 787 angiography in patients with hepatic cancer, 37 showed hepatic arterial occlusion. The origin and frequency of the collaterals in the 37 cases were observed and analyzed.Results The extrahepatic collaterals were most commonly originated from the right inferior phrenic artery and left gastric artery, with the frequency of 40.5% and 29.7%, respectively. And the frequency of collaterals originated from inferior pancreatoduodenal, gastroduodenal and superior mesenteric artery was 8%, 5.4% and 8%, respectively. Hepatic cancer located at the 7th or 8th segment of the right lobe mainly received blood supply via the collaterals from the right inferior phrenic artery, while the cancer located at the 5th or 6th segment of the right lobe mainly from the peri choledochal artery. The tumor feeding collaterals of the left lobe were mainly originated from the left gastric artery.Conclusion Extrahepatic collaterals are the major blood supply for hepatic cancer when the hepatic artery is occluded. An understanding of the site and frequency of the collaterals is very important for guiding the further treatment.