Eurvilaichit C
Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2000 Nov;83(11):1393-401.
Twenty patients with hepatocellular carcinoma who had hepatic artery occlusion from repeated transcatheter oily chemoembolization (TOCE), were treated with additional TOCE through extrahepatic collaterals. Repeated TOCE were performed through the inferior phrenic artery (10 patients), branches of the gastroduodenal artery (6 patients), the internal mammary artery (2 patients), the pancreatico-duodenal arcade (1 patient), the accessory hepatic artery (1 patient), the capsular branch of the right renal artery (1 patient) and the 12th intercostal artery (1 patient). The TOCE was unsuccessful in 4 patients with accessory hepatic artery, one patient with cystic artery arising from superior mesenteric artery, one patient with omentoepiploic artery and one patient with left gastric anastomose with right gastric artery. The success rate of TOCE in the extrahepatic arteries was 76.67 per cent while there was a 23.33 per cent failure rate. The overall cumulative survival rates were 80 per cent (6 months), 50 per cent (12 months) and 18.8 per cent (18 months). One patient developed skin necrosis at the right chest wall following TOCE of the right internal mammary artery for HCC. One patient developed hemiplegia following TOCE of the right 12th intercostal artery. The extrahepatic collaterals are important alternative routes for continuous transcatheter management of hepatocellular carcinoma following hepatic artery occlusion.
20例因反复经导管油性化疗栓塞术（TOCE）导致肝动脉闭塞的肝细胞癌患者，通过肝外 collateral 进行了额外的TOCE治疗。经膈下动脉（10例）、胃十二指肠动脉分支（6例）、胸廓内动脉（2例）、胰十二指肠动脉弓（1例）、副肝动脉（1例）、右肾动脉包膜支（1例）和第12肋间动脉（1例）进行了反复TOCE。4例副肝动脉患者、1例肠系膜上动脉发出的胆囊动脉患者、1例网膜动脉患者和1例胃左动脉与胃右动脉吻合患者的TOCE未成功。肝外动脉TOCE的成功率为76.67%，失败率为23.33%。总体累积生存率分别为80%（6个月）、50%（12个月）和18.8%（18个月）。1例患者在经右胸廓内动脉进行肝癌TOCE后，右胸壁出现皮肤坏死。1例患者在经右第12肋间动脉进行TOCE后出现偏瘫。肝外 collateral 是肝动脉闭塞后肝细胞癌持续经导管治疗的重要替代途径。
