Maeda Noboru, Osuga Keigo, Mikami Koji, Higashihara Hiroki, Onishi Hiromitsu, Nakaya Yasuhiro, Tatsumi Mitsuaki, Hori Masatoshi, Kim Tonsok, Tomoda Kaname, Nakamura Hironobu
Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan.
Radiat Med. 2008 May;26(4):206-12. doi: 10.1007/s11604-007-0216-5. Epub 2008 May 29.
The aim of this study was to assess the incidence, degree, and predictors of hepatic arterial damage (HAD) after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).
A total of 33 patients with unresectable HCC underwent TACE alone using a mixture of iodized oil, epirubicin, and gelatin sponge. A follow-up angiogram was available for 76 of 109 sessions, and HAD was evaluated at each subsegment of the hepatic artery using a three-grade scale (1, no or slight wall irregularity; 2, overt stenosis; 3, occlusion). Grades 2 and 3 were considered to indicate significant HAD. The predictors of HAD were analyzed by multivariate analysis.
A total of 161 hepatic arteries were embolized from the lobar (n = 43), segmental (n = 40), subsegmental (n = 72), or more distal (n = 6) level. The follow-up period between the initial and last sessions ranged from 70 to 1505 days (median 497 days). Significant HAD occurred in 37 of 231 subsegmental hepatic arteries (16%) and in 16 of 33 patients (48%). The accumulated dose of epirubicin per artery (P = 0.001) and Child-Pugh score (P < 0.001) were significant predictors.
TACE is more likely to induce HAD in cirrhotic patients with impaired liver function and when a high dose of the chemotherapeutic agent was used.
本研究旨在评估肝细胞癌（HCC）经动脉化疗栓塞术（TACE）后肝动脉损伤（HAD）的发生率、程度及预测因素。
33例不可切除的HCC患者仅接受了使用碘化油、表柔比星和明胶海绵混合物的TACE治疗。109次治疗中的76次有随访血管造影，采用三级评分法（1，无或轻度管壁不规则；2，明显狭窄；3，闭塞）对肝动脉各亚段的HAD进行评估。2级和3级被认为提示严重HAD。通过多因素分析对HAD的预测因素进行分析。
共对161条肝动脉进行了栓塞，栓塞部位为叶（n = 43）、段（n = 40）、亚段（n = 72）或更远端（n = 6）水平。首次与末次治疗之间的随访期为70至1505天（中位数497天）。231条肝动脉亚段中有37条（16%）发生严重HAD，33例患者中有16例（48%）发生严重HAD。每条动脉表柔比星的累积剂量（P = 0.001）和Child-Pugh评分（P < 0.001）是显著的预测因素。
TACE更有可能在肝功能受损的肝硬化患者以及使用高剂量化疗药物时诱发HAD。
