初次TACE治疗时存在右膈下动脉供血的肝细胞癌的特征分析

目的探讨右膈下动脉(RIPA)参与供血的肝细胞癌(HCC)的影像学表现及RIPA的解剖特征。方法回顾性分析106例于初次TACE治疗时行RIPA造影的HCC患者的MDCT及DSA资料,分析RIPA参与供血的HCC的生长特点及RIPA的解剖结构。结果 106例中46例发现RIPA参与HCC供血,肿瘤位于肝脏第Ⅳ～Ⅷ段;其中45例HCC呈外生型生长,28例为巨块型,肝动脉均处于开放状态。22例RIPA起源于腹主动脉(22/46,47.83%),8例起源于腹腔干动脉(8/46,17.39%),10例起源于右肾动脉(10/46,21.74%),3例起源于肝固有动脉(3/46,6.52%),3例起源于胃左动脉(3/46,6.52%)。结论对位于肝脏裸区或接近右侧横膈的肝段呈外生型、巨块状生长的HCC,初次TACE治疗时应行RIPA造影,以明确其是否参与肿瘤供血。

Characteristics of hepatocellular carcinoma supplied by right inferior phrenic artery at initial TACE

Objective To observe the characteristics of hepatocellular carcinoma （HCC） supplied by right inferior phrenic artery （RIPA） at initial TACE. Methods Totatly 106 patients with HCC who underwent RIPA angiography at the initial TACE were analyzed retrospectively. The growth characteristic of HCC supplied by RIPA and the anatomic characteristics of RIPA were observed. Results HCC in 46 patients were supplied by RIPA, which located in liver segment IV--~. Exo- phytic growth of HCC was noticed in 45 patients, while massive type in 28 patients. The hepatic arteries were intact in all 46 patients. Twenty-two （22/46, 47.83%） RIPA originated from the aorta, 8 （8/46, 17.39%） from celiac trunk, 10 （10/46, 21.74%） from right renal artery, 3 （3/46, 6.52%） from proper hepatic artery, and 3 （3/46, 6.52%） from left gastric artery. Conclusion For HCC at the liver bare area or under the right diaphragm with exophytic growth pattern and massive type, it is necessary to perform RIPA angiography at the first TACE to watch whether it supplies the tumor.