原发性肝癌首次TACE治疗时RIPA参与肿瘤供血的影响因素分析  

Causative factors of right inferior phrenic artery participating in blood supply of primary liver cancer at initial session of transcatheter arterial chemoembolization

作　　者：罗家敏 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13期1388-1392,共5页Journal of Third Military Medical University

摘　　要：目的分析原发性肝癌首次经动脉插管化疗栓塞时右侧膈下动脉(right inferior phrenic artery,RIPA)参与肿瘤供血的相关影响因素,作为术前判断其是否存在供血的重要参考依据。方法回顾性分析我院161例原发性肝癌首次行插管化疗栓塞时即行右侧膈下动脉造影者的MRI或CT、DSA资料,按肿瘤是否有RIPA参与供血分RIPA组与NRIPA组,分析两组病例肿瘤大小、位置、包膜,并对其行单因素分析及多因素logistic回归分析。结果 161例中RIPA参与肿瘤供血77例(47.8%),单因素分析显示肿瘤大小(P<0.01)、是否累及肝包膜(P=0.034)、肿瘤有无完整包膜(P<0.01)、肿瘤主要部分所在肝段(P<0.01)在两组间有统计学差异,多因素logistic回归分析显示肿瘤大小分类、有无完整包膜及肿瘤主要部分所在肝段为首次TACE治疗时RIPA参与肿瘤供血的独立预测因素。结论原发性肝癌首次TACE治疗时,当肿瘤为位于肝裸区或膈下的大肝癌,尤其是位于VII段且无完整包膜者,RIPA参与肿瘤供血的机会增加。Objective To analyze the causative factors of right inferior phrenic artery（ RIPA）participating in the blood supply of primary liver cancer（ PLC） at initial session of transcatheter arterial chemoembolization（ TACE） so as to provide important reference for judging whether there is blood supply from RIPA before TACE. Methods A retrospectively analysis was performed on the radiological data（ MRI,CT or DSA） of 161 PLC patients who underwent RIPA angiography at the first TACE treatment in our hospital from November 2010 to November 2013. The patients were divided into RIPA group and non-RIPA group according to whether RIPA participated in tumor blood supply. Tumor size,location and tumor capsule were analyzed and compared between the 2 groups. Univariate and multivariate analyses were performed in this study. Results Among the 161 cases,77 cases（ 47. 8%） were founded to have the blood supply from RIPA at initial TACE session. Univariate analysis showed that tumor size（ P〈0. 01）,involving the liver capsule（ P = 0. 034）,intact tumor capsule（ P〈0. 01） and liver segment of tumor location（ P〈0. 01） were significantly associated with the blood supply. Multiple logistic regression analysis showed that the tumor size,intact tumor capsule and liver segment of tumor location were independent predictive factors for whether the PLC has blood supply from RIPA or not at initial TACE session. Conclusion When PLC is located in the bare area or directly beneath the diaphragm and of massive type,especially located in segment 7 and without an intact capsule,there are more chances for RIPA participating in blood supply of PLC at initial TACE session.

关 键 词：原发性肝癌 经动脉插管化疗栓塞 右侧膈下动脉 肿瘤血供 影响因素 

分 类 号：R331.37[医药卫生—人体生理学] R730.53[医药卫生—基础医学]