副胃左动脉在肝癌介入治疗中的意义

目的探讨副胃左动脉在肝细胞癌介入治疗中的临床意义。方法对387例确诊原发性肝细胞癌患者行64层螺旋CT检查,动脉期采用容积再现(VR)及最大密度投影(MIP)技术重建肠系膜上动脉及腹腔动脉分支起源及走行,并与血管造影对比。结果 387例均清楚显示腹腔动脉、脾动脉、胃左动脉、肝总动脉、肝固有动脉、肝左动脉、肝右动脉及胃十二指肠动脉;282例清楚显示胃右动脉起源。共发现副胃左动脉50例,其中46例发自肝左动脉远端,1例发自副肝左动脉远端,1例发自肝右动脉近端,2例发自肝固有动脉。三维重建结果与血管造影一致。结论副胃左动脉多起源于肝左动脉远端,正确认识副胃左动脉可以避免肝细胞癌介入治疗过程中异位栓塞的发生,减少并发症具有实用意义。

The significance of accessory left gastric artery in interventional treatment for hepatocellular carcinomas

Objective To discuss the clinical significance of the accessory left gastric artery in the interventional treatment for hepatocellular carcinomas(HCC).Methods The dynamic enhanced CT scanning of the liver with a 64-lice spiral CT unit was performed in 387 HCC patients.In arterial phase, maximum intensity projection(MIP) and volume reconstruction(VR) techniques were used to display the origins and courses of the superior mesenteric artery,celiac artery and their hranches.The findings were compared with the angiographic results.Results The celiac arteries,splenic arteries,left gastric arteries, common hepatic arteries.proper hepatic arteries,left hepatic arteries,right hepatic arteries and gastroduodenal arteries were clearly displayed on CT images in all the 387 cases.The origins of the right gastric arteries were distinctly revealed in 282 cases.The anomalous origins of accessory left gastric arteries were found in 50 cases,including distal end of left hepatic artery(n = 46),distal end of accessory left hepatic artery(n = 1 ),proximal end of right hepatic artery(n = 1) and proper hepatic artery(n = 2).The results obtained from three - dimensional reconstruction images were in good accordance with angiographic findings.Conclusion The anomalously originated accessory left gastric arteries most commonly originate from the distal end of left hepatic arteries.Proper understanding of the anomalously originated accessory left gastric arteries is very helpful in performing the interventional management for HCC.The ectopic embolization can be avoided and the complications can be reduced.