肝细胞癌患者的肝动脉造影：肿瘤引流肝静脉球囊闭塞引起的结果变化

Hepatic arteriography in patients with hepatocellular carcinoma: change in findings caused by balloon occlusion of tumor-draining hepatic veins.

作者信息

Kanazawa S, Yasui K, Doke T, Mitogawa Y, Hiraki Y

机构信息

Department of Radiology, Okayama University Medical School, Japan.

出版信息

AJR Am J Roentgenol. 1995 Dec;165(6):1415-9. doi: 10.2214/ajr.165.6.7484576.

DOI:10.2214/ajr.165.6.7484576

PMID:7484576

Abstract

OBJECTIVE

A previous study suggested that temporary occlusion of a segment of the hepatic vein causes an increase in arterial flow and retrograde portal flow in the occluded segment. Such occlusions might improve the efficacy of arterial infusion therapy. Accordingly, we studied the change in blood flow visible on hepatic arteriograms when a segment of the hepatic vein is temporarily occluded in patients with hepatocellular carcinoma.

MATERIALS AND METHODS

The study group consisted of 24 patients with nodular-type hepatocellular carcinoma. Conventional hepatic arteriography was followed by hepatic arteriography performed using a balloon catheter to occlude the hepatic vein that was most closely associated with the tumor. Visualization of the tumor-draining veins, portal vein branches, the degree of tumor vascularity, and the density of the hepatogram on the hepatic arteriogram were retrospectively compared before and during venous occlusion. The veins were evaluated visually; an increase of tumor vascularity was defined as an increase in the number of countable tumor vessels during occlusion, and a dense hepatogram was considered to be a definite sinusoidgram induced by venous occlusion.

RESULTS

Conventional hepatic arteriography showed the tumor-draining veins to be branches of the portal vein in only two of the 24 patients (8%). Hepatic arteriography during venous occlusion, however, showed the tumor-draining veins to be branches of the portal vein in four of the patients (17%). An increase in the degree of tumor vascularity with venous occlusion was observed only in a patient with an initial arteriohepatic vein shunt. Dense hepatogram and hepatofugal opacification of the portal vein branches in the occluded, tumor-bearing segment were obtained in 10 patients (42%). Eight of these did not have liver cirrhosis, whereas all of the remaining 14 patients did (p < .001).

CONCLUSION

Our results suggest that occlusion of a segment of the hepatic vein may be useful during arterial infusion of hepatocellular carcinoma.

摘要

目的

先前的一项研究表明，暂时阻断一段肝静脉会导致被阻断节段的动脉血流增加以及门静脉逆行血流增加。这种阻断可能会提高动脉灌注治疗的疗效。因此，我们研究了肝细胞癌患者暂时阻断一段肝静脉时肝动脉造影可见的血流变化。

材料与方法

研究组由24例结节型肝细胞癌患者组成。先进行常规肝动脉造影，然后使用球囊导管进行肝动脉造影以阻断与肿瘤关系最密切的肝静脉。回顾性比较静脉阻断前后肝动脉造影上肿瘤引流静脉、门静脉分支、肿瘤血管程度以及肝影像密度。静脉通过肉眼评估；肿瘤血管增加定义为阻断期间可计数的肿瘤血管数量增加，密集的肝影像被认为是由静脉阻断引起的明确的肝血窦影像。

结果

常规肝动脉造影显示，24例患者中只有2例（8%）的肿瘤引流静脉是门静脉分支。然而，静脉阻断期间的肝动脉造影显示，4例患者（17%）的肿瘤引流静脉是门静脉分支。仅在一名最初存在动脉-肝静脉分流的患者中观察到静脉阻断时肿瘤血管程度增加。10例患者（42%）在被阻断的、有肿瘤的节段获得了密集的肝影像和门静脉分支的肝外门静脉显影。其中8例没有肝硬化，而其余14例患者均有肝硬化（p <.001）。