膈下动脉碘油化疗药物栓塞治疗肝癌

Transcatheter lipiodol chemoembolization of the inferior phrenic artery in hepatocellular carcinoma

目的 评价膈下动脉碘油化疗药物栓塞对肝癌治疗的疗效及膈下动脉供血的肿瘤的部位。方法 2 5例肝癌 ,巨块型 12例、结节型 8例、多发结节型 5例。均采用Seldingers法行肝动脉和膈下动脉碘油化疗药物及明胶海绵颗粒栓塞。结果 膈下动脉发自于腹腔干起始处者 16例 ,占 6 4 % ,直接发自主动脉腹腔干周围者 8例 ,占 32 %。其中供应右叶 (Ⅶ ,Ⅷ段 ) 2 3例 ;肿瘤位于左叶 (Ⅳ段 )膈下者2例。膈下动脉碘油化疗药物栓塞后累积 1、2年生存率分别是 84 %和 6 8%。未出现严重并发症。结论 经膈下动脉碘油化疗药物栓塞治疗肝癌是一种安全有效的方法。当肿瘤位于膈下 ,邻近膈肌 ,肝韧带或肝裸区 ,特别是肝动脉造影时肿瘤染色有缺损或无肿瘤染色 ,但肿瘤在CT上有增强或血AFP升高时 ,应考虑到肿瘤由膈下动脉供血。

Objective To evaluate the efficacy of transcatheter lipiodol chemoembolization therapy (TOCE) for HCC via inferior phrenic artery (IPA) and to analyse the location of the tumor feeding inferior phrenic artey. Methods Twenty five cases of HCC underwent the procedure of TOCE via the IPA, as well as the hepatic artery using Seldinger's method. The patterns of tumor growth included huge type in 12 cases, solitary nodular type in 8 cases and multiple nodular type in 5 cases. Hepatic artery and inferior phrenic artery chemoembolizations were performed in all cases. Results Inferior phrenic artery originated from celiac trunk in 16 cases (64%); abdomen aorta around celiac trunck in 8(32%). The sitesot tumors supplied by IPA in right lobe (Ⅶ,Ⅷ segment) were 23 cases and left lobe (Ⅳ segment) 2 cases. The cumulative survival rates of IPA chemoembolization for hepatocellular carcinoma were 84%(1 year) and 68%(2 years). No severe complications occurred. Conclusions TOCE of the IPA is a safe and effective method in the management of HCC supplied by IPA. When the tumor site is adjacent to diaphragm, hepatic ligaments or bare area, may arouse the blood supply by IPA, especially in no tumor staining or staining defect in hepatic artery angiography but tumor enhancement on CT, and increase of the level of serum α fetoprotein.