网膜动脉参与原发性肝癌血供之影像特征及栓塞治疗的临床价值  

Imaging features of hepatocellular carcinoma with blood supply from omental artery and clinical value of transcatheter arterial chemoembolizetion

作　　者：王宇西[1] 罗小平[1] 刘曦[1] 何明菊[1] 杨伟[1] 

机构地区：[1]重庆医科大学附属第二医院放射科,重庆400010

出　　处：《第三军医大学学报》2015年第8期816-820,共5页Journal of Third Military Medical University

摘　　要：目的探讨大网膜动脉参与原发性肝癌血供的影像特征及完全性栓塞治疗的临床价值。方法收集本院2010-2014年行经导管肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）治疗发现大网膜动脉（omental artery,OA）参与原发性肝癌供血患者的影像及临床资料,回顾性分析OA参与肿瘤供血时的影像特征,评估OA完全性栓塞治疗的安全性及有效性。结果 36名患者于41次TACE治疗发现OA参与肿瘤供血。病灶均突破肝包膜,病灶位于肝S4、5段且于大网膜方向突破者13例（31.7%）,位于肝S5、6段且向下方外生生长者18例（43.9%）。53支OA参与肿瘤供血,血管造影特征明显。49支OA（92.5%）成功超选择性插管并完全性栓塞,未发现严重并发症。mRECIST方法分析28例,完全缓解（complete response,CR）9例,病灶强化半径至少减小30%为部分缓解（partial response,PR）13例,既未达到缓解也未达到进展标准者为稳定（stable disease,SD）2例,病灶强化半径至少增加30%为进展（progressive disease,PD）4例,OA供血病灶栓塞有效率（response rate,RR）为78.6%,肿瘤生长控制率（disease control rate,DCR）为85.7%。再次行TACE治疗15例,仅2例（13.3%）可见新生OA参与肿瘤供血。结论 OA多参与位于肝S4-6段,并突破肝包膜或侵犯大网膜的大肝癌供血,血管造影特征明显。完全性栓塞OA肿瘤供血支安全性高,疗效好。Objective To explore the imaging features of hepatocellular carcinoma（ HCC） with blood supply from omental artery（ OA） and the clinical value of complete transcatheter arterial chemoembolization（ TACE）. Methods The image data and clinical data of patients with HCC with blood supply from OA,who underwent TACE in our hospital from 2010 to 2014,were collected. The imaging features were analyzed,and the safety and effectiveness of complete TACE were evaluated retrospectively.Results HCC with blood supply from OA was found in 36 patients who underwent TACE for 41 times. In all patients,tumors showed exophytic growth. The tumors of 13 patients（ 31. 7%） were mainly located in liver segments 4-5 and showed exophytic growth in epiploic direction. The tumors of 18 patients（ 43. 9%） were mainly located in liver segments 5-6 and downwards broke through the hepatic capsule. There were 53 OAs found to supply blood to HCC,and angiographic features were clear. Totally,49 OAs（ 92. 5%） were completely occlusive,and no serious complication was recorded. Among 28 cases analyzed with a modified response evaluation criteria in solid tumor（ mRECIST） method,there were 9 cases in complete response（ CR）,13 cases in partial response（ PR）,2 cases in stable disease（ SD）,and 4 cases in progressive disease（ PD）. Response rate（ RR） was 78. 6%,and disease control rate（ DCR） was 85. 7%. Fifteen cases underwent the next TACE,and only 2 cases had new OAs found to supply blood to tumors. Conclusion OAs mostly involve in blood supply of massive HCC,which is located in liver segments 4-6 and breaks through the hepatic capsule or infringes the neighboring greater omentum,and vascular imaging features are clear.Complete chemoembolization of OAs is a relatively safe,feasible and valuable method.

关 键 词：原发性肝癌 经导管肝动脉化疗栓塞 大网膜动脉 完全性栓塞 

分 类 号：R322.121[医药卫生—人体解剖和组织胚胎学] R730.44[医药卫生—基础医学]