在选择性球囊阻断经动脉化疗栓塞期间肝细胞癌结节中碘化油乳剂的密集积聚：球囊阻断动脉残端压力的测量。
Dense accumulation of lipiodol emulsion in hepatocellular carcinoma nodule during selective balloon-occluded transarterial chemoembolization: measurement of balloon-occluded arterial stump pressure.
机构信息
Department of Radiology, Hitachi General Hospital, Jyonann 2-1-1, Hitachi, Ibaraki 317-0077, Japan.
出版信息
Cardiovasc Intervent Radiol. 2013 Jun;36(3):706-13. doi: 10.1007/s00270-012-0476-z. Epub 2012 Sep 21.
PURPOSE
To reveal the mechanism of dense accumulation of lipiodol emulsion (LE) in hepatocellular carcinoma (HCC) during selective balloon-occluded transarterial chemoembolization (B-TACE).
METHODS
Balloon-occluded arterial stump pressure (BOASP) at the embolization portion was measured during selective B-TACE for 43 nodules in 42 patients. Fluoroscopy and digital subtraction angiography were prospectively observed during selective B-TACE to note whether dense LE accumulation in HCC occurred. The LE concentration ratio of HCC to embolized liver parenchyma (LECHL ratio) was also calculated for each treatment on the basis of the computed tomographic scan obtained immediately after selective B-TACE. The relationships between degree of LE accumulation and the BOASP, as well as the LECHL ratio, were analyzed.
RESULTS
Arterial flow beyond the catheter tip was maintained even after balloon inflation. In 39 of 43 treatments, LE inflow into the nontumorous liver parenchyma ceased immediately after LE droplets were filled in arteries of the nontumorous liver parenchyma while LE inflow into the HCC nodule continued (group 1). More dense LE accumulation in HCC nodule was obtained in these 39 treatments. In four treatments, LE inflow both into the nontumorous liver parenchyma and into the HCC nodule continued, and no dense LE accumulation in HCC nodule was observed (group 2). In these four treatments, thick anastomotic vessels with collateral artery were noted. The BOASP in group 1 was (mean ± SD) 33.8 ± 12.8 mmHg (range 13-64 mmHg) and that in group 2 was 92.3 ± 7.4 mmHg (range 83-100 mmHg). There was a statistically significant difference in BOASP between groups (p = 0.00004, Welch's t test). The LECHL ratio in group 1 was 18.3 ± 13.9 (range 2.9-54.2) and that in group 2 was 2.6 ± 1.1 (range 1.7-4.2). There was a statistically significant difference in the LECHL ratio between the groups (p = 0.000034, Welch's t test).
CONCLUSION
Selective B-TACE induced dense LE accumulation in HCC nodules in 39 (91 %) of 43 treatments in which BOASP was 64 mmHg or less.
目的
揭示选择性球囊阻断经动脉化疗栓塞（B-TACE）期间碘化油乳剂（LE）在肝细胞癌（HCC）中密集积聚的机制。
方法
对 42 例 43 个结节的选择性 B-TACE 过程中栓塞部位的球囊阻断动脉残端压力（BOASP）进行了测量。在选择性 B-TACE 过程中前瞻性透视和数字减影血管造影观察是否发生 HCC 中密集的 LE 积聚。还根据选择性 B-TACE 后即刻获得的 CT 扫描计算 HCC 与栓塞肝实质（LECHL 比值）的 LE 浓度比。分析 LE 积聚程度与 BOASP 和 LECHL 比值之间的关系。
结果
即使在球囊充气后，导管尖端以外的动脉血流仍保持通畅。在 43 次治疗中的 39 次中，当 LE 液滴充满非肿瘤性肝实质的动脉时，LE 流入非肿瘤性肝实质立即停止，而 LE 流入 HCC 结节继续（第 1 组）。在这 39 次治疗中，获得了更密集的 HCC 结节中的 LE 积聚。在 4 次治疗中，LE 流入非肿瘤性肝实质和 HCC 结节都继续，并且未观察到 HCC 结节中密集的 LE 积聚（第 2 组）。在这 4 次治疗中，注意到有厚的吻合血管和侧支动脉。第 1 组的 BOASP 为（平均值±标准差）33.8±12.8mmHg（范围 13-64mmHg），第 2 组为 92.3±7.4mmHg（范围 83-100mmHg）。两组间 BOASP 差异有统计学意义（p=0.00004，Welch's t 检验）。第 1 组的 LECHL 比值为 18.3±13.9（范围 2.9-54.2），第 2 组为 2.6±1.1（范围 1.7-4.2）。两组间的 LECHL 比值差异有统计学意义（p=0.000034，Welch's t 检验）。
结论
在 BOASP 为 64mmHg 或更低的 43 次治疗中的 39 次（91%）中，选择性 B-TACE 诱导 HCC 结节中密集的 LE 积聚。
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