Shin Sung Wook, Do Young Soo, Choo Sung Wook, Lieu Wei Chiang, Cho Sung Ki, Park Kwang Bo, Yoo Byung Chul, Kang Eun Hae, Choo In-Wook
Department of Radiology and Center for Imaging Sciences, Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea.
Radiology. 2006 Nov;241(2):581-8. doi: 10.1148/radiol.2412051209. Epub 2006 Sep 27.
To prospectively assess the diaphragmatic anatomic and functional consequences of transcatheter arterial chemoembolization (TACE) of the inferior phrenic artery in patients with hepatocellular carcinoma.
Informed consent and institutional review board approval were obtained. Fifteen patients (13 men, two women; mean age, 52 years; age range, 22-61 years) who underwent TACE of the inferior phrenic artery for treatment of hepatocellular carcinoma were enrolled. The right inferior phrenic artery was embolized in 14 patients, and the left inferior phrenic artery was embolized in one patient. Chest radiography, fluoroscopy, computed tomography (CT), and pulmonary function tests were performed before and after TACE of the inferior phrenic artery. The post-TACE examinations were performed 2-3 months after TACE, and the results were compared with those of the pre-TACE examinations. A paired t test or the Wilcoxon signed rank test was used for statistical analyses.
At chest radiography and fluoroscopy, six of 15 patients (40%) had both elevation and movement abnormality of the ipsilateral hemidiaphragm after TACE of the inferior phrenic artery. The mean (+/- standard deviation) diaphragmatic thickness on CT scans changed from 9.11 mm +/- 3.02 to 7.67 mm +/- 2.27 after TACE (P = .048). The mean vital capacity also was significantly decreased after TACE, from 91.87% +/- 18.52 to 82.27% +/- 16.94 of the predicted value (P = .006). The decreases in diaphragmatic thickness and vital capacity were most pronounced in the patients with abnormal findings at chest radiography and fluoroscopy.
After TACE of the inferior phrenic artery, a substantial portion of patients showed functional and anatomic evidence of diaphragmatic weakness.
前瞻性评估经导管动脉化疗栓塞术（TACE）治疗肝细胞癌患者时膈下动脉栓塞对膈肌解剖结构和功能的影响。
获得患者知情同意并经机构审查委员会批准。纳入15例行膈下动脉TACE治疗肝细胞癌的患者（13例男性，2例女性；平均年龄52岁；年龄范围22 - 61岁）。14例患者栓塞右膈下动脉，1例患者栓塞左膈下动脉。在膈下动脉TACE术前和术后进行胸部X线摄影、透视、计算机断层扫描（CT）及肺功能测试。TACE术后2 - 3个月进行检查，并将结果与TACE术前检查结果进行比较。采用配对t检验或Wilcoxon符号秩检验进行统计学分析。
在胸部X线摄影和透视检查中，15例患者中有6例（40%）在膈下动脉TACE术后出现同侧半膈肌抬高及运动异常。CT扫描显示，TACE术后膈肌平均厚度（±标准差）从9.11 mm±3.02变为7.67 mm±2.
