无法手术切除的胰腺癌数字减影血管造影(DSA)的动脉造影分析及其对经动脉灌注化疗(TAI)的指导价值  

The analysis of digital subtract angiography(DSA) in advanced pancreatic cancer and its value in transcathether infusion(TAI)

作　　者：施惠斌[1,2] 陈颐[1,2] 程洁敏[1,2] 龚高全[1,2] 李国平[1,2] 李长煜[1,2] 王小林[1,2] 

机构地区：[1]复旦大学附属中山医院介入治疗科 [2]上海市影像医学研究所,上海200032

出　　处：《复旦学报（医学版）》2014年第3期352-356,共5页Fudan University Journal of Medical Sciences

基　　金：上海市级医院新兴前沿技术项目(SHDC12010120);supported by the Program of Advanced Technology of Hospitals in Shanghai Grant(SHDC12010120)

摘　　要：目的观察无法手术切除的胰腺癌数字减影血管造影(digital subtract angiography,DSA)的表现特点,探讨DSA动脉造影对经动脉灌注化疗(transarterial infusion,TAD的指导价值。方法回顾性分析在中山医院介入治疗科接受TAI治疗的无法手术切除的胰腺癌患者146例。所有病例先行腹腔动脉和肠系膜上动脉造影,必要时选择进入肝总动脉、胃十二指肠动脉或脾动脉造影。观察胰腺癌的直接供血动脉及其起源、胰周主要动脉受侵犯情况。结果 61例胰头癌中,所有病例胰十二指肠前上、后上动脉均参与供血(100%),53例胰十二指肠前下、后下动脉参与供血(86.9%),14例胰背动脉参与供血(23.0%)。85例胰体尾癌中,9例未见明显血供,余76例中胰背动脉参与供血31例(36.5%),胰大动脉参与供血41例(48.2%),胰尾动脉参与供血35例(41.2%)。胰周大动脉中,16例腹腔动脉受侵犯(11.0%),其中2例动脉侵犯分级Ⅳ级;35例胃十二指肠动脉受侵犯(24.0%);10例肠系膜上动脉受侵犯(6.8%);8例肝总动脉受侵犯(5.5%);65例脾动脉受侵犯(44.5%),其中7例动脉受侵分级Ⅳ级。结论 DSA动脉造影对元法手术切除的胰腺癌TAI术中给药靶动脉的确有重要指导价值。Objective To observe the characteristic of digital subtract angiography （DSA） in advanced pancreatic cancer and its value in transcathether infusion （TAI）.Methods One hundred and fourty-six patients with advanced pancreatic cancer,who underwent TAI in Department of interventional radiology,Zhongshan hospital,were retrospectively analyzed.Celiac arterial and super mensenteric arterial angiography were first performed in all the patients.The common hepatic arterial,gastroduodenal arterial,or splenic arterial angiography were performed if necessary.The direct supplying artery of pancreatic cancer and its origin were observed.The invasion of peri-pancreatic main arteries by pancreatic cancer were also observed.Results In the 61 patients with lesion located in pancreatic head,61cases （100%） had the blood supply from the anterior/posterior superior pancreaticoduodenal artery,53（86.9%） from the anterior/posterior inferior pancreaticoduodenal artery,and 14 cases （23.0%） from the dorsal pancreatic artery.In the 85 patients with lesion located in pancreatic body or tail,the blood supply were not found in 9 cases.In the other 76 cases,31 cases （36.5%） had the blood supply from the dorsal pancreatic artery,41 cases （48.2%） from the great pancreatic artery,and 35 cases （41.2%） from the caudal pancreatic artery.In terms of peripancreatic main arteries,celiac artery was invaded in 16 cases （11.0%） with total occlusion in 2 cases,gastroduodenal artery in 35 cases （24.0%）,super mensenteric artery in 10 cases （6.8%）,common hepatic artery in 8 cases （5.5%）,and splenic artery in 65 cases （44.5%） with total occlusion in 7 cases.Conclusions The analysis of characteristic of DSA in advanced pancreatic cancer can be a useful guidance for the selection of target arterial in TAI.

关 键 词：胰腺癌 数字减影血管造影(DSA) 动脉灌注化疗(TAI) 

分 类 号：R816.5[医药卫生—放射医学]