Iwata Y, Endo J, Saito T, Iwata T, Matsuyama S, Tanaka Y, Otani Y, Tsukui S, Goto K, Ikeuchi S
Department of Radiology I, Tokai University Hospital, Kanagawa, Japan.
Tokai J Exp Clin Med. 1996 Dec;21(4-6):177-83.
Extrahepatic collateral pathways developing after repeated transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) make therapeutic arterial embolization for recurrent lesions extremely difficult. TAE was performed through the collateral pathways using a sophisticated micro-catheter with good trackability and pushability and a coaxial system. Twenty-three TAEs were undertaken through the collateral pathways in 13 patients with recurrent HCC who had extrahepatic collateral pathways after the previous hepatic arterial TAE. There were 69 extrahepatic collateral pathways, with partially obstructed hepatic arteries. On the average, three feeding arteries were seen in the liver. The main extrahepatic collateral pathways were the inferior phrenic artery and epicholedocal artery, 18 vessels and 29 vessels, respectively, accounting for about 80% of the total collateral pathways. TAEs were successful in all cases and the number of embolized vessels was 2.1 on average. The average time of the first collateral TAE after the initial conventional hepatic arterial TAE was 2.3 years. Excellent prognosis was observed with a one-year survival rate of 77% and 3-year survival rate of 38% after the collateral TAE. We consider that collateral TAE for recurrent HCC with obstruction of the hepatic artery is the procedure of choice, is technically feasible, and provides better prognosis for the patients.
肝细胞癌（HCC）经多次经导管动脉栓塞术（TAE）后形成的肝外 collateral 途径，使得对复发病变进行治疗性动脉栓塞极为困难。使用具有良好跟踪性和推送性的精密微导管及同轴系统，通过 collateral 途径进行 TAE。对 13 例复发性 HCC 患者进行了 23 次经 collateral 途径的 TAE，这些患者在先前肝动脉 TAE 后存在肝外 collateral 途径。共有 69 条肝外 collateral 途径，肝动脉部分阻塞。肝脏平均可见三条供血动脉。主要的肝外 collateral 途径是膈下动脉和胆囊旁动脉，分别为 18 支和 29 支，约占 collateral 途径总数的 80%。所有病例的 TAE 均成功，平均栓塞血管数为 2.1 支。初次常规肝动脉 TAE 后首次经 collateral 途径 TAE 的平均时间为 2.3 年。经 collateral 途径 TAE 后观察到预后良好，1 年生存率为 77%，3 年生存率为 38%。我们认为，对于肝动脉阻塞的复发性 HCC，经 collateral 途径 TAE 是首选的治疗方法，在技术上可行，且能为患者提供更好的预后。
