肠系膜上动脉供血型肝癌的血管造影分析及介入治疗

Hepatocellular carcinoma fed by the hepatic artery arising from the superior mensenteric artery:angiographic findings and interventional treatment

目的 :研究肠系膜上动脉供血型 (即变异肝动脉起源于肠系膜上动脉 )肝癌的血管造影表现及插管技术。方法 :回顾分析 41例肠系膜上动脉供血型肝癌的DSA及介入治疗资料 ,统计血管解剖变异的发生率 ,对其起源、走行、分支、分布等解剖学特征及其与血管插管的关系进行描述和分析。结果 :350例肝癌中肠系膜上动脉供血型 41例 (1 1 .9% ) ,其中副肝右动脉 1 5例 (36 .5 % ) ,替代肝右动脉 1 6例 (39.0 % ) ,肝总动脉 8例 (1 9.5 % ) ,腹腔动脉干起源于肠系膜上动脉 2例 (5 % )。 31例肠系膜上动脉发出替代或副肝右动脉者 ,2 9例 (94.0 % )腹腔动脉造影表现为肝右动脉细小或缺如 ,肝右叶出现无血管区。RH导管超选择性插管成功 2 5例 (61 % ) ,未成功者改用Cobra、Simmon导管以及结合微导管技术后获得成功。结论 :肠系膜上动脉供血型肝癌是一种比较常见的肝动脉变异性供血 。

Objective:To investigate angiographic characteristics and interventional catheterization techniques of hepatocullular carcinoma (HCC) fed by aberrant hepatic arteries arising from superior mensenteric artery (SMA),namely SMA type.Methods:DSA manifestations and data of interventional treatment in 41 SMA type HCCs were retrospectively reviewed.The frequency of aberrant arteries was summed up statistically and their anatomic characteristics(such as,origin,course,branches and distribution) and relationship with catheterization were described and analysed.Results:Of 350 HCC cases,SMA type HCCs were found in 41 cases(11.9%),including accessory right hepatic atery (15 cases,36.5%),replaced right hepatic artery(16 cases,39.0%),common hepatic artery (8 cases,19.5%) and celiac artery arising from SMA (2 cases,5%) .Of 31 cases with accesory or replaced right hepatic arteries,on celiac angiography,right hepatic arteries were small or absent in 29 cases(94.0%) ,and there was an avascular zone on the right liver.Superselective catheterization was successful in 25 cases (61%) by using RH catheter,the rest acquired successful superselective catheterization by using Cobra,Simmon catheter and microcatheter.Conclusion:SMA type is a common variation,A konwledge of this variation is very important in transcatheter arterial chemoembolization for HCC.