中晚期肝癌超选择插管困难的肝动脉分型和治疗策略

目的研究中晚期原发性肝癌在经动脉化疗栓塞治疗（TACE）中超选择插管困难患者的肝动脉形态、插管技巧和治疗对策。方法随机选取100例确诊的中晚期原发性肝癌患者,行TACE术,根据术中超选择插管的难易程度,分为易超选组和难超选组,分析两组在肿瘤大小的差异,统计采用Spss 12软件。分析难超选组的肝动脉形态,进行肝动脉分型,研究插管技巧及综合治疗策略。结果 100例患者中,易超选84例（84%）,超选择困难的16例（16%）,两组肿瘤大小比较差异无统计学意义（P〉0.05）,超选困难主要原因为肝动脉解剖因素,将其分为4型,Ⅰ型为向下开口长干型（4例）,其中肝右动脉发自肠系膜上动脉1例;Ⅱ型为肝动脉扭曲型（6例）;Ⅲ型为肝动脉纤细型（4例）;Ⅳ型为肝动脉闭塞型（2例）。Ⅰ型患者采用导管成袢法（2例）和微导管法（2例）;Ⅱ、Ⅲ型（10例）运用微导管超选成功;Ⅳ型血管介入困难,2例运用微导管均未成功。结论中晚期肝癌超选择插管困难的原因主要为肝动脉的解剖因素,和肿瘤大小无明显相关性。超选困难的肝动脉可分为4型,Ⅰ型为向下开口长干型,Ⅱ型为肝动脉扭曲型,Ⅲ型为肝动脉纤细型,Ⅳ型为肝动脉闭塞型。Ⅰ型可采用导管成袢法或微导管法;Ⅱ、Ⅲ型运用微导管多可超选成功;Ⅳ超选困难,适宜采用非血管介入治疗。

Hepatic Artery Difficult Classification of Advanced Hepatocellular Carcinoma Superselective Catheterization and Treatment Strategies

Objective To study the advanced primary liver cancer in the transcarterial chemoembolization(TACE) in patients with difficult intubation superselective form of the hepatic artery,cannulation techniques and treatment strategies.Methods 100 cases diagnosed with advanced primary liver cancer were randomly selected and divided into easy group and hard group,operated with TACE surgery,according to the technical ease of superselective catheterization,tumor size differences in the two groups were analyzed in stati...