肝外滋养动脉在原发性肝癌介入治疗中的意义

摘要

Objective: To investigate the effects of extrahepatic (not from liver) nutrient arteries on the interventional treatment of primary hepatic carcinoma. Methods:The DSA results of 500 cases of primary hepatic carcmoma, treated in our hospital during March 2009 to August 2010, were retrospectively analyzed and evaluated. In some of these cases, the extrahepatic nutrient arteries were found and then treated by using the transcatheter arterial chemotherapy embolism (TACE) technique. Results:Totally 40 extrahepatic nutrient arteries, which were involved in the blood supply of liver carcinoma carcinoma were found in 36 cases. Six of these cases were found in the first interventional treatment and 20 were found after multiple operations. Five cases were found after surgical operation and additional five were found after epidermal chemical and physical ablation. The massive liver carcinoma was found in 26 of these cases. These extrahepatic nutrient arteries include the right inferior phrenic artery (26 cases) , right adrenal gland artery (1), right internal mammary artery (1) , left gastric artery (3) , right colic artery branches (3) , epiploic artery (2) , gastroduodenal artery (4) , and pancreati-coduodenal artery (3). There were two extrahepatic tumor nutrient arteries found in four patients. The operational results were markedly improved after TACE treatment of those extrahepatic nutrient arteries. Conclusion: The presence of extra-hepatic nutrient arteries affected the effectiveness of clinical treatment of hepatic carcinoma. The identification and TACE treatment of extrahepatic nutrient arteries could further improve the results of the clinical treatments, particularly in the cases in which patients had been subjected to multiple TACE treatments.%目的:研究原发性肝癌肝外滋养动脉(非肝脏发出的动脉)在介入治疗原发性肝癌中的意义.方法:回顾性分析2009年3月～2010年8月本院500例原发性肝癌的DSA资料.寻找肝癌肝外滋养动脉的起源,并采用微导管行灌注化疗及栓塞治疗.结果:共发现36例患者存在40条肝外滋养动脉参入肿瘤供血.首次介入治疗发现6例,多次介入治疗发现20例,外科手术治疗后发现5例及经皮化学或物理消融术后发现5例.巨块型肝癌26例.其中右膈下动脉23例,右肾上腺动脉1例,右侧内乳动脉1例,胃左动脉3例,右结肠动脉分支3例,网膜动脉2例,胃十二指肠动脉4例,胰十二指肠动脉3例.其中4例患者存在2条肝外肿瘤滋养动脉.上述动脉均成功采用微导管插入行灌注化疗及栓塞,取得较好疗效.结论:肝外滋养动脉的存在直接影响肝癌治疗的疗效,尤其对多次介入治疗后的肝癌患者,积极寻找肝外肿瘤滋养动脉并行栓塞治疗,可进一步提高疗效.