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目的探讨在原发性肝癌(PLC)右膈下动脉供血介入治疗(TACE)中的临床价值。方法回顾分析右膈下动脉(RIPA)参与供血的36例PLC患者的介入治疗资料。所有患者均行RIPA造影,观察RIPA的解剖及供血情况,对参与供血的RIPA行超选择性TACE治疗。结果 36例中RIPA起自腹主动脉前壁17例;起自腹腔动脉开口处9例;起自右肾动脉开口处4例;起自右肾动脉主干6例。RIPA供血PLC表现为病灶对比剂染色淡薄或残缺不全有17例(47.2%);表现为碘油沉积有缺损者有10例(27.8%);表现为肝动脉狭窄、变细或闭塞有6例(16.7%);表现为巨大肿瘤位于右膈下有23例(63.9%);表现为术后AFP不降甚至升高有21例(58.3%)。结论在PLC治疗过程中,重视寻找和栓塞参与PLC供血的RIPA,对提高右膈下动脉供血介入治疗疗效具有重要的临床意义。
Objective To investigate the clinical value of transcatheter arterial infusion of right subphrenic artery (TACE) in primary hepatocellular carcinoma (PLC). Methods The data of interventional therapy of 36 patients with PLC who were involved in the supply of blood by the right subphrenic artery (RIPA) were retrospectively analyzed. All patients underwent RIPA angiography to observe the anatomy and blood supply of RIPA, and to perform superselective TACE on RIPA involved in blood supply. Results In 36 cases, RIPA originated from 17 cases of anterior abdominal aorta, from the opening of celiac artery in 9 cases, from the opening of right renal artery in 4 cases and from the right renal artery in 6 cases. There were 17 cases (47.2%) with RIPA donor stains showing weak contrast or incomplete staining of the contrast agent, 10 cases (27.8%) with defective lipiodol deposition, 6 cases of hepatic artery stenosis, thinning or occlusion (16.7%). Twenty-three patients (63.9%) showed massive tumors located in the right subphrenic area. 21 cases (58.3%) showed non-decreased or even elevated AFP after operation. Conclusion In the process of PLC treatment, it is important to find and embolize RIPA involved in PLC blood supply, which has important clinical significance in improving the therapeutic effect of the right subphrenic artery blood supply.