Yamagami Takuji, Kato Takeharu, Tanaka Osamu, Hirota Tatsuya, Nishimura Tsunehiko
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
J Vasc Interv Radiol. 2005 Apr;16(4):457-63. doi: 10.1097/01.RVI.0000152388.97231.75.
For therapeutic effectiveness of repeated hepatic arterial infusion chemotherapy (HAIC) for unresectable advanced liver malignancies, distribution of anticancer drugs via an indwelling catheter should be uniform throughout the entire liver. It was investigated how an extrahepatic artery entering the posterior segment or caudate lobe of the liver influences performance of repeated HAIC.
One hundred ninety-five patients with unresectable advanced liver cancer underwent placement of a percutaneously implantable port-catheter system and were followed arteriographically with and without computed tomography (CT). The frequency of poor distribution in the posterior segment or caudate lobe of the liver was observed on CT during arteriography via the port for HAIC. The correlation between poor distribution and various factors including the number of intrahepatic arteries was studied, and the management of such poor distribution is described.
In 34 of 195 patients (17.4%), poor distribution was observed in the posterior segment and/or caudate lobe of the liver. The rate of poor distribution was significantly higher in those with two or more hepatic arteries than in those with one (13 of 35 vs 21 of 160; P = .0007, chi2 test). Other evaluated factors were not significantly correlated with such poor distribution. The right inferior phrenic artery was successfully embolized in 22 patients with tumors in segments with poor distribution. Good distribution throughout the entire liver was achieved in 21 patients (95.5%).
Inflow of the right inferior phrenic artery into the liver occasionally prevents distribution of anticancer drugs throughout the entire liver during performance of long-term HAIC.
对于不可切除的晚期肝脏恶性肿瘤，重复肝动脉灌注化疗（HAIC）的治疗效果取决于抗癌药物通过留置导管在整个肝脏中的均匀分布。本研究旨在探讨进入肝脏后段或尾状叶的肝外动脉如何影响重复HAIC的效果。
195例不可切除的晚期肝癌患者接受了经皮植入式端口导管系统置入术，并在有或无计算机断层扫描（CT）的情况下进行了动脉造影随访。在通过端口进行HAIC的动脉造影期间，通过CT观察肝脏后段或尾状叶分布不佳的频率。研究了分布不佳与包括肝内动脉数量在内的各种因素之间的相关性，并描述了对这种分布不佳的处理方法。
195例患者中有34例（17.4%）在肝脏后段和/或尾状叶观察到分布不佳。有两条或更多肝动脉的患者分布不佳的发生率显著高于只有一条肝动脉的患者（35例中的13例 vs 160例中的21例；P = 0.0007，卡方检验）。其他评估因素与这种分布不佳没有显著相关性。22例分布不佳节段有肿瘤的患者成功栓塞了右膈下动脉。21例患者（95.5%）实现了整个肝脏的良好分布。
右膈下动脉流入肝脏偶尔会在长期HAIC过程中阻止抗癌药物在整个肝脏中的分布。
