肝-胃动脉的解剖学基础及其在肝癌经导管动脉内化疗栓塞中的意义

目的：研究肝－胃动脉（hepatogastric,artery,HGA的DSA表现特征，探讨其在肝癌经导管动脉内化疗栓塞（transcatheter arterial chemoembolization,TACE)术中的意义。方法：回顾分析1000例肝动脉DSA造影片，将起源于肝固有动脉（proper hepatic artery,PHA)以远各级肝动脉的胃及十二指肠的供血动脉命名为HGA，并根据其走行方向及分布范围的不同，进一步将其分为胃右动脉（right gastric artery,RGA)，迷走胃左动脉（aberrant left gastric artery，AbLGA)，迷走胃十二指肠动脉（aberrang gastroduodenal artery,AbGDA)，迷走胃网膜右动脉（aberrant right gastroepiploic artery,AbRGEA)，十二指肠上动脉（superior duodenal artery,SDA)及其他不易明确命名的HGA等。分别统计其发生率，描述其起源，走行，分支，分布等解剖学特征。结果：1000例中，740例存在1支以上的HGA，占74％，共显示839支HGA，其中RGA682支（81．29％，682／839），AbLGA84支（10．01％，84／839），SDA45支（5．36％，45／839），AbGDA21支（2．50，21／839），AbRGEA1支（0．12％，1／839），其他HGA6支（0．72％，6／839）。839支HGA中，起源于PHA412支（49．11％，412／839），起源于肝左动脉（left hepatic artery,LHA)314支（37．43％，314／839）,起源于肝右动脉（right hepatic artery,RHA）98支（11．68％，98／839），起源于肝中动脉（middle hepatic artery,MHA)15支（1．79％，15／839）。结论：HGA是比较常见的肝－胃，十二指肠间的血管变异，研究HGA的解剖变异对预防肝癌TACE术后胃肠道并发症的发生具有重要的临床意义。

The X-ray vascular anatomy of hepatogastric arteries and their significance in transcatheter arterial chemoembolization in patients with hepatocellular carcinoma

Objective To study the characteristics of hepatogastric artery (HGA) with DSA and its clinical significance in transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma. Methods One thousand cases of hepatic DSA arteriograms had been retrospectively reviewed. The aberrant gastrointestinal arteries that originated from proper hepatic artery (PHA) or distal intrahepatic arteries to PHA were named HGA. Furthermore, according to their different courses and distributions, HGAs were subdivided into right gastric artery (RGA), aberrant left gastric artery (AbLGA), aberrant gastroduodenal artery (AbGDA), aberrant right gastroepiploic artery (AbRGEA), superior duodenal artery (SDA) and other difficult-to-named HGA. The incidence of each of them had been summed up and their anatomic characteristics such as origin, course, branches, and distribution had been described. Results Of the 1000 cases, at least one branch of HGA was found in 740 cases (74%), and altogether there were 839 branches of HGA in them. The composition of 839 branches of HGA was as follows: 682 branches of RGA (81.29%, 682/839), 84 branches of AbLGA (10.01%, 84/839), 45 branches of SDA (5.36%, 45/839), 21 branches of AbGDA (2.50%, 21/839), 1 branch of AbRGEA (0.12%, 1/839) and 6 branches of difficult-to-named HGA (0.72%, 6/839). Of the 839 branches of HGA, 412 branches originated from PHA (49.11%, 412/839), 314 branches from left hepatic artery (LHA)(37.43%, 314/839), 98 branches from right hepatic artery (RHA)(11.68%, 98/839), and 15 branches from middle hepatic artery (MHA)(1.79%, 15/839). Conclusion HGA is a common gastrointestinal arterial variation and it is very important to be familiar with it so as to prevent the gastrointestinal complications after TACE in patients with hepatocellular carcinoma.