经导管肝内动脉化疗栓塞治疗肝细胞癌的疗效和安全性。

Efficacy and safety of transcatheter chemoembolization of the internal thoracic artery in patients with hepatocellular carcinoma.

机构信息

Department of Interventional Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.

出版信息

Chin Med J (Engl). 2011 May;124(9):1374-80.

Abstract

BACKGROUND

Embolization of collateral arteries is important for transcatheter hepatic arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). We evaluated the efficacy and safety of TACE, and the prevention and management of complications among patients in whom the internal thoracic artery (ITA) was involved.

METHODS

A total of 3614 cases of HCC were treated with 12 645 TACEs and 211 of these cases were given ITA angiography, including 156 cases of which the ITA was involved. We performed 562 TACEs in the 156 cases. We analyzed imaging examinations, types of embolization, and the incidence, prevention, and treatment of complications.

RESULTS

The ITA was successfully embolized in 156 cases. Angiography of the ITA showed that the major trunks were thickened with an increased number of branching vessels, contributing to intrahepatic and extrahepatic tumor blood supply. Different embolization methods were selected according to the blood supply, to effectively embolize the tumor and mitigate or avoid serious complications. TACE with ITA embolization extended the mean interval time between two treatments from 2.54 months (1 - 17 months) to 4.23 months (1 - 30 months) compared with that without ITA embolization. The ITA supplied the HCC in the following instances: HCC was located in the ventral hepatic area and abutted the diaphragm (P = 0.0064) and repeated TACE (P = 0.0003). The survival rate of TACE with ITA embolization for HCC was better than TACE without ITA embolization (P < 0.00001).

CONCLUSIONS

In cases with massive HCC or nodular HCC, the ITA may be involved in supplying blood to the tumor. This occurs when the tumor is positioned in the ventral hepatic area and abuts the diaphragm (S2, S4, and S8), and especially if cases have a previous history of TACE. In this case series, embolization was effective, extended the mean interval time of interventional therapy, and prolonged survival time.

摘要

背景

在肝细胞癌（HCC）患者中，栓塞侧支动脉对于经导管肝动脉化疗栓塞（TACE）至关重要。我们评估了 TACE 的疗效和安全性，以及在涉及胸廓内动脉（ITA）的患者中预防和管理并发症。

方法

共对 3614 例 HCC 患者进行了 12645 次 TACE 治疗，其中 211 例进行了 ITA 血管造影，其中 156 例 ITA 受累。我们对 156 例患者进行了 562 次 TACE。我们分析了影像学检查、栓塞类型以及并发症的发生率、预防和治疗。

结果

ITA 在 156 例患者中成功栓塞。ITA 血管造影显示，主干增厚，分支血管增多，有助于肝内和肝外肿瘤的血液供应。根据供血情况选择不同的栓塞方法，有效地栓塞肿瘤，减轻或避免严重并发症。与未进行 ITA 栓塞的 TACE 相比，ITA 栓塞的 TACE 将两次治疗之间的平均间隔时间从 2.54 个月（1-17 个月）延长至 4.23 个月（1-30 个月）。ITA 供应 HCC 的情况如下：HCC 位于肝腹侧区域并毗邻膈肌（P=0.0064）和重复 TACE（P=0.0003）。ITA 栓塞的 TACE 治疗 HCC 的生存率优于未进行 ITA 栓塞的 TACE（P<0.00001）。