肝动脉解剖变异在中晚期肝癌介入治疗中的意义

The anatomic variations of hepatic artery and their clinical significance on interventional therapy of moderate and advanced hepatocarcinoma

目的 探讨放射学肝动脉解剖变异及其在中晚期肝癌介入导管治疗中的临床意义。方法 回顾性分析 12 5例中晚期肝癌肝动脉造影表现及其介入治疗资料。结果 12 5例中 10 7例 ( 85 6 % )有典型肝动脉分布。肝动脉变异 18例( 14 4 % ) ,其中肝右动脉变异 10例 ( 8% ) ,而又以肝右动脉始于肠系膜上动脉者最多 ,占 6 4 %。副肝左动脉变异 1例( 0 8% )。肝左动脉和肝右动脉同时变异 2例 ( 1 6 % )。肝总动脉变异 3例 ( 2 4 % )。胃十二指肠动脉起自肝右动脉和腹腔动脉各 1例 ( 1 6 % )。对 12 3例成功进行了肝动脉化疗栓塞 ,2例肝右动脉变异因角度关系超选插管未成功。

Objective To evaluate hepatic arterial variations seen at angiography and its clinical value on interventional therapy of moderate and advanced hepatocarcinoma. Methods Hepatic angiographic images in 125 cases with moderate and advanced hepatocarcinoma were analysed. Results One hundred and seven (85 6%) cases had the standard hepatic arterial anatomy. Variant hepatic arteries were found in 18 (14 4%) cases. Ten (8%) cases had variant right hepatic arteries mostly originated from mesenteric superior artery (6 4%). One (0 8%) case had accessory variant left hepatic arteries. Two (1 6%) cases had a variant anatomy involving both the left and the right hepatic arteries. Three (2 4%) cases had a variant origin of the common hepatic artery arising from the superior mesenteric artery. Two (1 6%) cases had variant gastroduodenal artery. One hundred and twenty three patients underwent hepatic arterial emboliza tion for the treatment of hepatocarcinoma, and two patients failed to perform superselective hepatic angiography for variant anatomy. Conclusion Meticulous angiographic evaluation of the hepatic arterial anatomy and its variations is important and very helpful for accuracy of intubation of hepatic artery and improvement of therapeutic effect of the TAI/TACE.