膈下动脉参与肝肿瘤供血的影像表现和介入治疗效果

Imaging and Interventional Therapy of Subphrenic Artery Involved in Hepatic Tumor Blood Supply

目的:探讨膈下动脉参与肝肿瘤供血的影像表现和介入治疗效果。方法:选取2017年5月-2018年5月经血管造影证实为膈下动脉参与肝脏肿瘤供血患者44例。对向肿瘤供血的膈下动脉分支进行栓塞治疗,4例采应用同轴微导管,40例用5FCobra导管。分析患者肿瘤位置分布情况、并发症发生率、成功率及患者治疗前后甲胎蛋白(AFP)水平。结果:44例患者中,4例(9.1%)患者肿瘤位于肝脏深部,40例(90.9%)患者肿瘤接近或累及肝脏表面。44例均为右膈下动脉参与肝脏肿瘤供血,主干明显增粗是主要临床表现;出现膈肌痉挛患者共计5例,并发症发生率为11.4%,该并发症在30 min后得到自主缓解。出现顽固性呃逆的患者2例,并发症发生率为4.5%,该并发症在3 d后得到自主缓解。44例患者栓塞全部成功,30例患者栓塞一次性成功,14例患者经2次膈下动脉栓塞成功;治疗后,患者的甲胎蛋白水平较治疗前明显降低,差异有统计学意义(P<0.05)。结论:对患者进行血管造影取得了较好效果,对于位于肝脏上部、接近肝包膜或膈肌的肿瘤,可以应用右膈下动脉供血进行有效的化疗栓塞,但是在治疗过程中应对顽固性呃逆和膈肌痉挛等并发症进行有效控制。

Objective:To investigate the imaging findings and interventional effects of the infraorbital artery in the blood supply of liver tumor.Method:Forty-four patients with hepatic tumors who were confirmed by angiography as an infraorbital artery were selected from May 2017 to May 2018.Embolization was performed on the branch of the infraorbital artery supplying blood to the tumor,4 cases were treated with coaxial microcatheters,and 40 cases were treated with 5 FCobra catheters.The patients’tumor location distribution,complication rate,success rate and alpha-fetoprotein(AFP)levels before and after treatment were analyzed.Result:Among the 44 patients,4 cases(9.1%)had tumors located deep in the liver,and 40 cases(90.9%)had tumors that approached or affected the liver surface.Forty-four patients were involved in the blood supply to the liver by the right inferior phrenic artery.The main clinical manifestations of thickening of the main trunk were 5 cases of iliac tendon,and the complication rate was 11.4%.The complication was autonomously relieved after 30 minutes.In 2 patients with refractory hiccups,the complication rate was 4.5%,and the complications were autonomously relieved after 3 days.All the 44 patients had successful embolization,30 patients had successful embolization by once time,and 14 patients had successful subcondylar embolization by twice time.After treatment,the alpha-fetoprotein level of the patients was significantly lower than that before treatment,the difference was statistically significant(P<0.05).Conclusion:The angiography of patients has achieved good results.For tumors located in the upper part of the liver and close to the hepatic capsule or diaphragm,the right infraorbital artery can be used for effective chemoembolization,but it should be resistant to effectively control the intractable hiccups and complications such as diaphragmatic spasm during treatment.