右肾上腺动脉参与肝细胞肝癌血供之经导管动脉化学治疗栓塞的临床价值

Clinical value of transcatheter arterial chemoembolization therapy for hepatocellular carcinoma with blood supply from right adrenal artery

目的探讨右肾上腺动脉参与肝细胞肝癌血供之经导管动脉化学治疗栓塞（TACE）治疗的临床价值。方法收集2012年至2016年行TACE治疗发现右肾上腺动脉参与肝细胞肝癌供血患者的影像学及临床资料，回顾性分析右肾上腺动脉完全性栓塞治疗的安全性及有效性。结果20例患者于23次治疗发现右肾上腺动脉参与肝细胞肝癌供血，病灶均侵犯并突出肝包膜外生长。病灶直径〉50mm者14例。3例患者首次行TACE治疗时发现右肾上腺动脉参与肝细胞肝癌供血，余17例患者于第2-6次TACE治疗时发现右肾上腺动脉参与肝细胞肝癌供血。右肾上腺上、中、下动脉供血者分别为13、3、9例。24支右肾上腺动脉（96．0％）成功超选择性插管并完全性栓塞，未发生严重并发症。肝癌改良实体肿瘤疗效评价标准方法分析20例随访病例结果显示，其中完全缓解3例，部分缓解9例，病情稳定2例，病情进展6例，右肾上腺动脉供血病灶栓塞有效率为60．0％，病灶发展控制率为70．0％。结论右肾上腺动脉多参与位于肝S5-S7段，并突破肝包膜侵犯右肾上腺的肝细胞肝癌供血，数字减影血管造影特征明显，易于发现。介入栓塞治疗右肾上腺动脉肿瘤供血支安全性高，疗效良好。

Objective To study the clinical value of transcatheter arterial chemoembolization （TACE） therapy for hepatocellular carcinoma with blood supply from right adrenal artery. Methods An imaging and clinical data of HCC patients with blood supply from right adrenal artery were collected from 2012 to 2016 after TACE treatment in the Second Affiliated Hospital of Chongqing Medical University and the safety and therapeutic efficacy of complete emholization therapy was analyzed retrospectively. Results Twenty hepatocellular carcinoma patients with blood supply from right adrenal artery had received 23 times treatment. All lesions had invaded and protruded from the exogenous development of liver capsule. There were 14 cases with lesions 〉 5 cm in diameter. Right adrenal artery was found to be involved in the blood supply of three cases of hepatocellular carcinoma during TACE treatment for the first time. In addition, the remaining 17 cases had also received TACE treatment for the second to sixth time. The superior, middle, and inferior adrenal arteries were involved in 13, 3, and 9 cases, respectively. Twenty-four right adrenal arteries （96.0%） superselectively cannulated were successfully embolized without any serious complications. The standard method for evaluating the efficacy of liver cancer in 20 solid tumors follow-up cases showed that three cases were completely relieved, nine cases were partially relieved, two cases were stable, and six cases were progressive. The effective rate of embolization with blood supply from right adrenal artery lesions was 60.0%, and the control rate of lesion development was 70.0%. Conclusion The right adrenal artery is mainly located in the $5-$7 segments of the liver. TACE features are obvious to ascertain its safety and effectiveness in the treatment of right adrenal artery tumors.