原发性肝癌肝外侧支血供动脉的特点和介入治疗分析

Characteristics of the extrahepatic collateral vessels in primary hepatocellular carcinoma and the interventional treatment

目的分析原发性肝癌患者肝外侧支血供动脉的发生情况及其对介入栓塞治疗的影响。方法选取行经导管肝动脉化疗栓塞术的350例原发性肝癌患者,分析原发性肝癌患者肝外侧支血供的发生率、发生部位、介入栓塞治疗效果及肝外侧支供血动脉的发现时机等。结果 350例患者中发生肝外侧支血供73例,占20.86%,其中肝外侧支动脉85条,主要以右膈下动脉、胃十二指肠及网膜动脉为主,分别占41.18%和18.82%。经1次介入治疗,肝外侧支血供动脉的发现率为6.86%,经多次介入治疗其发现率为14.00%,随着介入治疗次数的增多,肝外侧支血供动脉的发现率升高,差异有统计学意义(P﹤0.05)。肝外侧支血供动脉中插管成功率为90.59%(77/85),手术结束1周后,甲胎蛋白(AFP)值下降者占87.67%(64/73)。结论原发性肝癌肝外侧支血供动脉发生率较高,且分布复杂,对肝外侧支血供动脉进行介入栓塞治疗,有利于提高介入治疗疗效。

Objective To analyze the incidence of extrahepatic collateral vessels in patients with primary hepatocel-lular carcinoma （HCC） and the influence on trans-catheter arterial chemoembolization （TACE）. Method 350 cases of HCC treated with TACE were chosen, the incidence, location and timing of extrahepatic collateral vessels, and the ef-fect of TACE were evaluated. Result In 350 patients, 73 cases （20.86%） had extrahepatic collateral vessels, in which there were 85 extrahepatic collateral arteries, mainly were right inferior phrenic artery （41.18%） , gastroduodenal artery （18.82%） and gastroepiploic artery;After 1 cycle of interventional treatment, the detection rate for extrahepatic collater-al vessels was 6.86%, and then rose up to 14.00%after multiple cycles of interventional treatment, suggesting a signifi-cant correlation between the treatment and detection rate （P〈0.05）. 90.59%（77/85） of extrahepatic collateral vessels had successful catheterization;In 1 week after surgery, AFP decreases were observed in 87.67%（64/73） of patients. Conclu-sion Extrahepatic collateral arteries are common in primary hepatocellular carcinoma, with complicated distribution, while trans-catheter arterial chemoembolization is an effective therapy.