原发性肝癌肝外侧支血供的介入治疗

目的：探讨原发性肝癌肝外侧支血供的特点和介入治疗。方法：回顾性分析因原发性肝癌多次行经皮肝动脉化疗栓塞术的患者343例，对存在肝外侧支供血的病例，采用选择性插管或应用微导管超选择性插管进行肿瘤的介入栓塞治疗。结果：71例患者共有83条肝外侧支动脉，发生率为20.7%（71/343）。包括右膈下动脉（41.0%）、胃十二指肠及网膜动脉（18.1%）、右肾上腺或肾包膜动脉（12.1%）、胆囊动脉（8.4%）、肋间动脉（6.0%）、肠系膜上动脉分支（4.8%）、腰动脉（3.6%）、胃左动脉（3.6%）和右内乳动脉（2.4%）。对这些动脉的选择性插管成功率为92.8%（77/83）。所有插管成功的动脉均进行了化疗栓塞或单纯的碘化油栓塞。结论：原发性肝癌多次化疗栓塞后，需要重视肝外侧支血供的存在并给予超选择性栓塞治疗，对于提高肝癌的介入治疗效果具有十分重要的临床意义。

Interventional therapy for extrahepatic collateral arterial supply of primary hepatic carcinoma

Objective： To study the character of extrahepatic collateral arterial supply of primary hepatic carcinoma and its interventional therapy.Methods： 343 patients with primary hepatic carcinoma who underwent transcatheter arterial chemoembolization for many times were retrospectively analyzed.The interventional therapy of transcatheter arterial chemoembolization was performed by selective catheterization or superselective catheterization in the patients with extrahepatic collateral arteries.Results： A total of 83 extrahepatic collateral arteries were found in 73 patients.The incidence was 20.7%（71/343）.They originated from right inferior phrenic artery（41.0%）,gastroduodenal and epiploic artery（18.1%）,right adrenal artery or subcapsular artery（12.1%）,cystic artery（8.4%）,right intercostal artery（6.0%）,superior mesenteric artery（4.8%）,lumbar artery（3.6%）,left gastric artery（3.6%）,and right internal mammary artery（2.4%）,respectively.The successful rate of super selective catheterization of extrahepatic collateral arteries was 92.8%（77/83）.The transcatheter arterial chemoembolization or arterial embolization with lipiodol was performed in the arteries of successful catheterization.Conclusions： It is necessary to determine the existence of extrahepatic collateral arterial supply and perform the super selective transcatheter arterial embolization in primary hepatic carcinoma with repeated TACE,which is clinically significant to improve the efficacy of interventional therapy.