520例原发性肝癌的供血动脉临床分析

探讨肝癌的动脉供血规律,指导肝癌的介入治疗.520例肝癌动脉栓塞前常规腹腔动脉造影或肝总动脉造影,对疑有肝动脉变异的再行肠系膜上动脉和/或腹主动脉造影,分析DSA图像.结果表明只有熟悉肿瘤变异动脉供血,才能确保肝动脉插管的准确性和化疗栓塞的彻底性.     

108例血管插管造影在肝癌诊断中的意义

对108例临床诊断为肝内占位的病人行血管造影118人次,其中腹腔动脉造影66人次,灌输性肝动脉造影48人次,肠系膜上动脉造影4人次。造影结果诊断为肝恶性肿瘤者87例,21例不能作出诊断,确诊率为80.6％。作者指出:插管造影成功的关键是熟悉腹腔动脉开口部位及变异;掌握导管在血管内成袢的技巧。同时还认为;肿瘤>5cm或欲了解门静脉有否瘤栓等,腹腔动脉造影足以达到诊断目的.小肝癌、左肝癌及宜行手术、栓塞治疗者,灌输性肝动脉造影很有价值。     

肝癌异位供血介入治疗的临床研究

经导管肝动脉化疗栓塞 (ＴＡＣＥ)是肝癌非手术治疗中的首选疗法 ,但肝癌的异位供血是直接影响ＴＡＣＥ疗效的重要因素之一。我们通过对 34例肝癌异位供血介入治疗 ,分析探讨对异位供血的介入处理和价值。一、材料与方法1 临床资料 :本组男性 2 9例 ,女性 5例。年龄 36～ 6 7岁 ,平均年龄 5 2 .7岁。全部患者均经临床检查、甲胎蛋白测定、Ｂ超、ＣＴ和血管造影综合确诊。其中原发性肝癌 2 7例 ,肝转移瘤 5例 ,肝癌术后复发 2例。2 方法 :采用Ｓｅｌｄｉｎｇｅｒ法经皮股动脉穿刺插管 ,行常规腹腔动脉造影。其中肠系膜上动脉造影 19例 ,超选…     

外国学者访华学术讲演关于肝癌血管造影及栓塞术

肝癌患者AFP不升高的约有10-15％。AFP在500ng左右时,与肝硬变、肝炎鉴别困难,此时应做CT或血管造影检查。肝癌治疗用栓塞术有二目的,一是手术前栓塞,二是单纯栓塞合并药物治疗。肝血管造影插管采用Seldinger法。(1)腹腔动脉造影-导管放入腹腔动脉,也可放人肝总动脉、肝右或肝左动脉进行超选择造影。造影剂用76％泛影葡胺8-10ml/秒,总量30-60ml。(2)门脉造影一在脾脏吸收后随静脉血进入门脉系统。(3)上肠系膜动脉(SMA)门脉造影法一经SMA注人前列腺素20单位(lAmP)加生理盐水10ml,(一次注入用5-10秒),注药后50-60秒准备摄片,经导管注入76％泛影葡胺,10-12     

肝外动脉供血在TACE治疗原发性肝癌临床意义的探讨

目的:探讨肝癌肝外动脉在介入治疗原发性肝癌中的意义.方法:回顾性分析2009-03-2010-08山东省肿瘤医院200例原发性肝癌患者的DSA资料.所有患者行常规腹腔动脉造影及肝外动脉探查,并对其行超选择性插管及化疗栓塞治疗(TACE).结果:200例患者共接受257次TACE治疗,36例患者存在47条肝外动脉参入肿瘤供血,主要来自膈下动脉(10例),肋间动脉(4例),内乳动脉(1例),网膜动脉(3例),胃十二指肠动脉(8例),肠系膜上动脉的分支(10例).33例患者肝外动脉均行超选择性插管和化疗栓塞治疗,其余3例患者肝外动脉困未能成功超选择性插管而经皮射频消融治疗后CR.结论:肝外动脉的存在直接影响肝癌治疗的疗效,对肝外动脉供血支超选择性栓塞治疗,对提高TACE的疗效具有十分重要的意义.     

原发性肝癌肝外动脉供血在介入治疗中的意义

目的 探讨原发性肝癌的肝外动脉供血情况,提高肝癌介入治疗的疗效.方法 本组52例原发性肝癌患者行常规腹腔动脉造影及肝外动脉探查,并对其行超选择性插管和化疗栓塞治疗.结果 52例患者共见57条肝外动脉,其中膈下动脉16条,肠系膜上动脉13条,右肾上腺动脉及右肾动脉10条,胃左动脉7条,胃十二指肠动脉5条,胃网膜动脉2条,...     

右膈下动脉CTA成像对肝癌介入治疗的价值

目的 利用CTA方法评估右膈下动脉(RIPA)的起源以及肝癌时其内径的变化,为介入治疗提供有效的影像依据.方法 125例患者均进行MDCT动脉期扫描,通过后处理软件进行RIPA重组.结果 所有125例中,RIPA均得到显示.RIPA起源部位多变,起源于腹主动脉者51例(40.8%),腹腔干49例(39.2%),胃左动脉3例(2.4%),肝固有动脉2例(1.6%),右肾动脉20例(16.0%).此外,左右膈下动脉共干者35例.在肝癌患者中,RIPA增粗,血管内径明显高于正常肝脏者(P＜0.05).结论 PIPA起源于多个动脉;就RIPA内径而言,肝癌患者血管内径明显高于正常人;CTA在评估肝外供血动脉方面可以提供很多有用的信息.     

肝动脉插管化疗栓塞术治疗原发性肝癌65例血管造影分析

肝动脉插管化疗栓塞术的应用，大大提高了中晚期肝癌患者的生存率。根据国内外资料报道均提示了重复治疗的重要性。重复治疗前行血管造影并分析其特点和规律，对观察肿瘤的变化，判断疗效和确定重治方案都具有一定的意义。现就我院的资料报告如下。资料与方法在施行肝动脉插管化疗栓塞术治疗原发性肝癌患者中，筛选具有二次以上血管造影复查的65例进行分析。其中巨块型对例（50。76％），结节型14例（21I．53％），弥漫型18例（27．71％）。用feldingnr及其改良法经股动脉穿刺将导管置入腹腔动脉或肝固有动脉，进行常规血管造影。首次治疗…     

晚期肝癌肝脏内外侧支供血及临床意义

探讨肝癌肝脏内，外侧支供血的产生机理。方法：收集ＴＡＥ治疗资料完整的中晚期肝癌３４０例，对其血管造影表现进行分析。结果；肝内侧支供血２２７例：叶间侧支２０７例，叶内侧支２０例；肝外侧支供血７８例；胃左肝左动脉共干２１例，网膜动脉２９例，右ＩＰＡ１３例，左ＩＰＡ５例，结肠中动脉９例，右贤动脉１例；肝内合并肝外侧支同时供血３５例。     

CT对原发性肝癌碘油栓塞后的随访价值

目的 探讨肝癌介入治疗后CT平扫、双期增强及3DCT对肝癌肝动脉插管化疗及碘油栓寨治疗(LP-TACE)术后的随访价值.方法 43例肝癌LP-TACE治疗后行CT平扫及双期增强扫描,10例同时行MIP、曲面重建.结果 43例肝癌LP-TACE治疗后碘油沉积形态分4个类型:完全型、缺损型、簇集型和稀少型.35例LP-TACE治疗后肿瘤内见非坏死低密度区,增强后18例动脉门静脉双重供血型,10例动脉供血型.4例门静脉供血型,3例少血供型.10例肝动脉及门静脉血管MIP、曲面重建可显示肝动脉及门静脉与非坏死低密度区的关系.结论 CT三期扫描及三维重建是显示肝癌LP-TACE治疗后残留病灶、反映其血供变化的有效方法,对制订新的治疗方案有指导意义.     

Angiographic findings of extrahepatic branches originating from hepatic artery and its clinical significance

Objective: To observe the presentation and variation of extrahepatic branches originating from hepatic artery by hepatic arteriography.Methods: Hepatic arteriogram of 200 cases with unresectable hepatic primary or metastatic tumors before interventional therapy were retrospectively analyzed. Two interventional radiologists independently reviewed the type, originating artery, distribution and variation of extrahepatic artery.Results: Five types of extrahepatic artery were found, with the most common type of the right gastric artery (n=156, 78%), followed by the cystic artery (n=126, 63%), accessory left gastric artery (n=19, 9.5%), hepatic falciform artery (n=5, 2.5%), and accessory left inferior phrenic artery (n=4, 2%). In 188 cases, there were extrahepatic arteries derived from hepatic proper artery or its branches, and the most frequent originating site was the right hepatic artery (130 extrahepatic branches), followed by the proper hepatic artery (103 branches), left hepatic artery (56 branches) and middle hepatic artery (3 branches). The left hepatic artery was the arising site with the multiple types of extrahepatic branches including all above branches except the cystic artery.Conclusion: Many types of extrahepatic branches usually derive from the hepatic artery or its distal branches, and its originating sites are not constant. It is important to avoid damage of extrahepatic tissue during interventional therapy for liver tumors.     

Long-term regional chemotherapy for colorectal liver metastasis: significance of hepatic arterial anatomy in the surgical placement of the implantable infusion device

The range and frequency of aberrant hepatic arterial anatomies and their significance for placement of implantable hepatic arterial infusion devices have been studied. The angiographs of 1439 patients treated at the Institute's Clinic (1985-2002) were used. The following 6 types of aberrant hepatic arterial anatomy were identified (J. Hiatt et al). Normal anatomy (type 1) was the most frequent (67.6%). The abnormal variants included: the aberrant left hepatic artery (LHA) running from the left gastric artery (LGA) (type 2)--9.9%; the aberrant right hepatic artery (RHA)--from the superior mesenteric artery (SMA) (type 3)--9.2%; the aberrant LHA from LGA with the aberrant RHA from SMA (type 4)--3.8%); the common hepatic artery running from SMA (type 5)--1.5%: other variants (type 6)--8.0%. Aberrant hepatic arterial anatomy occurred in every third patient. It was responsible for failed perfusion, frequent thrombosis of both hepatic arteries and infusion devices, suspension of regional chemotherapy and affecting its effectiveness. Proper identification of aberrant hepatic artery anatomy is vital for placement of implantable infusion systems.     

A simplified surgical technical procedure for intra-arterial chemotherapy in secondary liver cancer. Experience in 50 patients

The purpose of this study was to prove that only one intra-arterial catheter for hepatic chemotherapy can perfuse the whole liver in all anatomic cases, including cases with aberrant or accessory hepatic arteries. The ligations of various hepatic arteries induce the immediate aperture of intra hepatic arterial shunts and a total revascularization of the whole liver by the only remaining hepatic artery. Based on the experience from 50 consecutive cases of surgical implantation of intra-arterial catheters for local chemotherapy, the simplified technique is analysed principally as a function of anatomical variations of the hepatic artery. The usual procedure (catheter implanted into the gastro-duodenal artery) was performed in 58% of the cases, while in 28% of the cases this was possible only after section of a right and/or a left aberrant or accessory hepatic artery. Unusual implantations were necessary in 14% of the cases to ensure complete perfusion of liver. The evaluation was based on three criteria: intra-operative perfusion of fluorescein, post-operative scan with 99mTc macro-aggregated albumin and objective clinical responses after intra-arterial chemotherapy. The perfusion of the whole liver was good in all cases except one. Unusual procedures gave the same clinical objective responses after intra-arterial chemotherapy (61%) as usual procedures (48%) (chi-square: P = 0.40).     

原发性肝癌肝外侧支血供动脉的特点和介入治疗分析

目的：分析原发性肝癌患者肝外侧支血供动脉的发生情况及其对介入栓塞治疗的影响。方法选取行经导管肝动脉化疗栓塞术的350例原发性肝癌患者,分析原发性肝癌患者肝外侧支血供的发生率、发生部位、介入栓塞治疗效果及肝外侧支供血动脉的发现时机等。结果350例患者中发生肝外侧支血供73例,占20.86%,其中肝外侧支动脉85条,主要以右膈下动脉、胃十二指肠及网膜动脉为主,分别占41.18%和18.82%。经1次介入治疗,肝外侧支血供动脉的发现率为6.86%,经多次介入治疗其发现率为14.00%,随着介入治疗次数的增多,肝外侧支血供动脉的发现率升高,差异有统计学意义（P﹤0.05）。肝外侧支血供动脉中插管成功率为90.59%（77/85）,手术结束1周后,甲胎蛋白（AFP）值下降者占87.67%（64/73）。结论原发性肝癌肝外侧支血供动脉发生率较高,且分布复杂,对肝外侧支血供动脉进行介入栓塞治疗,有利于提高介入治疗疗效。     

Intrahepatic arterial flow distribution after ligation of a right replaced hepatic artery. A case report

A basic requirement for arterial chemotherapy of liver tumors is complete catheter perfusion of the liver. In cases with atypical anatomy of the hepatic artery, it is frequently impossible to obtain this goal by means of a single catheter. In a patient with a right replaced hepatic artery, the aberrant vessel was ligated and the left hepatic artery was perfused through a catheter inserted into the gastroduodenal artery. Perfusion scans performed through the catheter 14 and 135 days after arterial ligation showed a fall in the arterial flow to the right liver (right/left ratio 0.43 and 0.60). In contrast, a nearly complete perfusion of the liver (0.91 right/left ratio) was obtained 28 days after ligation, when the perfusion scan was performed immediately after catheter infusion of 90,000,000 degradable starch microspheres (DSM: diameter = 40 m). DSM administration is supposed to increase back pressure in the lobe receiving native circulation, thus activating intrahepatic collateral flow to the ischemic lobe. As regards regional treatment of liver tumors, obvious conclusions are to be drawn.     

肝动脉解剖变异在肝癌介入治疗中的临床价值

 目的 探讨肝动脉解剖变异在肝癌介入治疗中的临床价值。方法 本文收集2003年1月～2004年6月在同济医院放射科做肝动脉化疗栓塞术（TACE）和肝动脉栓塞（TAE）的中晚期肝癌150例，将每例病人的肝动脉造影所见与临床资料及随访结果一起进行分析。结果 150例中，有肝动脉变异者23例，占全部病例的15．3％。结论 表明肝动脉变异发生率较高。同时发现有些病例虽然肝动脉及其分支无变异，但肝动脉走行位置变异，对选择性肝动脉插管有较大影响。作者对肝动脉变异的类型、肝动脉走行位置异常、以及它们在肝癌介入治疗中的意义进行了讨论。     

Repetitive chemo-embolization with degradable starch microspheres (DSM) to each left and replaced right hepatic artery in a patient with multiple liver metastases of colon cancer

In a patient with a right hepatic artery arising from the superior mesenteric artery bearing multiple liver metastases from colon cancer, hepatic arterial chemo-embolization was performed in combination with degradable starch microspheres (DSM) administered independently to the left and replaced right hepatic artery via a percutaneal approach. As the first line chemotherapy from hepatic artery with DSM 300 mg, 5-FU 500 mg and MMC 10 mg resulted in PD. DSM 300 mg, epirubicin (EPI) 50 mg, MMC 4 mg was administered with the RHA:LHA ratio of 3:1 as a second line. Four weeks later it was evaluated as NC by angiography and by tumor-marker dropped extremely. The same regimen was repeated every four weeks, and the NC status remained for 20 weeks in total. Each time, the left and replaced right hepatic artery got perfect re-perfusion and DSM enabled an effective whole liver distribution of anti-cancer drugs and repetitive administrations of them. This regimen could be an alternative choice for patients with a replaced right hepatic artery who have liver metastasis of colon cancer.     

MSCTA供血动脉成像在肝脏常见肿瘤中的临床应用

目的:探讨多层螺旋CT血管造影（multi-slice spiral CT angiography,MSCTA）供血动脉成像在肝脏常见肿瘤诊断及术前评估中的应用。方法:收集2010年至2013年间肝脏肿瘤性病变患者30例,常规平扫后增强扫描。扫描完成后薄层重建原始数据,行VR、MPR、MIP等重建方式,观察肝脏肿瘤供血动脉情况及肝动脉变异征像。结果:30例患者中,26例发现供血动脉,其中肝癌14例,肝母细胞瘤2例,肝血管瘤6例,局灶性结节增生（focal nodular hyperplasia,FNH）3例,肝血管平滑肌脂肪瘤1例,其中1例发现肝动脉变异。结论:运用MSCTA技术,可以确切的观察肝脏肿瘤一支或多支供血动脉及其形态表现,并可清晰显示动脉变异,对肿瘤病变术前诊断及手术、介入治疗方案设计具有重要的指导意义。     

肝癌的肝外动脉供血及其介入治疗

目的 探讨肝癌的肝外动脉供血规律、插管技术及介入治疗。方法 分析62例肝癌患者78条肝外动脉供血特征,对肝外动脉供血支行超选择插管,并同时进行肝动脉系统及肝外动脉供血支的双动脉化疗栓塞术。结果 肝外动脉供血占肝癌患者的43．1％,肝外动脉供血与肿瘤部位、大小密切相关;RH、Cobra、SP管配合使用,肝外动脉供血支插管成功率为71．8％。治疗后1个月复查,CT显示肿瘤缩小,碘油沉积致密完全。结论 肝癌有丰富的肝外动脉供血,对具有肝外动脉供血的肝癌患者采取双动脉内化疗栓塞是可行、必要和有效的。