肝动脉变异及其在肝癌介入治疗中的意义

目的:通过肝动脉造影观察肝动脉及其肝外分支的不同变异情况，为肝癌介入治疗提供影像学指导。方法:收集200例原发或转移性肝癌患者的介入术前肝动脉造影资料，2名介入科医生共同阅片观察Michels肝动脉变异分型，分析肝动脉变异发生概率、肝固有动脉缺失变异情况及肝动脉肝外分支的出现概率、起始部位的变异情况。结果:最常见的肝动脉变异是MichelsⅢ型17例（8.5%），其次是Ⅱ型10例（5.0%）和Ⅴ型9例（4.5%）。Ⅰ型中肝固有动脉缺失25例，且发现5种亚型。肝外供血分支5种，最常见的是胃右动脉肝外供血分支156例（78.0%），其次是胆囊动脉126例（63.0％）、副胃左动脉19例（9.5％）、肝镰状动脉5例（2.5%）、副左膈动脉4例（2.0％）。结论:肝动脉变异除Michels分型外尚有其他亚型，且肝动脉的肝外分支变异较多，充分认识这些变异有助于提高肝癌介入治疗效果，预防并发症发生。

Variation of hepatic artery on arteriogram and its clinical significance in interventional therapy for hepatic cancer

Objective To investigate the variations of hepatic artery and its extrahepatic arteries on hepatic arteriogram and to provide benefit for transhepatic arterical chemoemblization.Methods The hepatic arteriograms of 200 cases with unresectable hepatic malignant tumor before interventional therapy were analysed.Two interventional radiologists in common reviewed the incidences of various types according to Michels' classification,the absence of proper hepatic artery,and the variations of extrahepatic arteries originating from hepatic artery.Results The most common hepatic artery variation was Michels type Ⅲ(n=17,8.5%),followed by type Ⅱ(n=10,5.0%) and Ⅴ(n=9,4.5%).Proper hepatic absence was found in 25 cases and appeared as 5 subtypes.5 kinds of extrahepatic arteries were found.The most common extrahepatic artery was the right gastric artery(n=156,78.0%),followed by cystic artery(n=126,63.0%),accessory left gastric artery(n=19,9.5%),the hepatic falciform artery(n=5,2.5%),and accessory left inferior phrenic artery(n=4,2.0%).Conclusion There are some other variations of hepatic artery beside Michels' classification,and there are many variations of extrahepatic arteries originating from hepatic artery,it is important to assure interventional therapy effect for hepatic cancer and prevent complication.