右肾上腺动脉参与肝细胞肝癌TACE术后复发的肿瘤血供影像特征及相关因素分析

Imaging characteristics of right adrenal artery involved in tumor blood supply of hepatocellular carcinoma postoperative recurrence after TACE and its correlation factors

目的探讨右肾上腺动脉(RAA)参与肝细胞肝癌(HCC)经导管动脉化疗栓塞术(TACE)术后复发的肿瘤血供影像特征,并对其相关因素进行分析。方法收集该院TACE术后病灶复发并怀疑有RAA参与供血的肝细胞肝癌病例99例。以是否有RAA参与供血分RAA组与NRAA组,同时观察RAA组的影像特征,分析两组病例肿瘤直径、位置、右肾上腺是否受累、有无完整包膜,并对其行单因素分析及多因素Logistic回归分析。结果99例患者中RAA组46例(46.46%),NRAA组53例(53.54%)。单因素分析显示肿瘤直径(P<0.001)、肿瘤主要部分所在的肝段(P=0.020)、右肾上腺是否受累(P<0.001)及肝包膜完整与否(P<0.001)在两组间差异有统计学意义。Logistic回归分析显示肿瘤直径、瘤体所在肝段、右肾上腺是否受累及有无完整包膜与RAA参与肿瘤供血有关。结论当肿瘤位于肝肾间隙,尤其是位于Ⅵ、Ⅶ段的巨块型肝癌,右肾上腺受累且肿瘤部分突破包膜甚至无包膜者,RAA参与肿瘤供血的概率增加。

Objective To retrospectively analyze the imaging characteristics of right adrenal artery involved in tumor blood supply of hepatocellular carcinoma(HCC)postoperative recurrence after TACE,and to investigate the related factors.Methods A total of 99 cases of hepatocellular carcinoma with suspected involvement of RAA in blood supply were collected.Accroding to whether RAA was involved in blood supply,they were divided into the RAA group and the NRAA group.Meanwhile,imaging characteristics of the RAA group were observed.Tumor diameter,location,involvement of right adrenal gland and integrity of capsule were analyzed in the two groups.Univariate analysis and multivariate Logistic regression analysis were also performed.Results There were 46 cases(46.46%)in the RAA group and 53 cases(53.54%)in the NRAA group.Univariate analysis showed statistically significant differences in tumor diameter(P<0.001),liver segment where the tumor was mainly located(P=0.020),involvement right adrenal gland(P<0.001),and integrity of liver capsule(P<0.001)between the two groups.The results of Logistic regression analysis showed that the tumor diameter,liver segment where the tumor was located,the involvement of the right adrenal gland and the interity of the liver capsule were correlated with the involvement of RAA in tumor blood supply(P<0.05).Conclusion When the tumor is in the liver and kidney clearance,especially giant block typeⅥ,Ⅶin liver cancer,and the involvement of the right adrenal gland,tumor partially coated even without coated,the probability of RAA participating in tumor blood supply increased.