CAJ | 학술논문

目的：分析右侧膈下动脉(RIPA)在多层螺旋CT血管三维重建中的表现，探查其解剖与变异在肝癌介入治疗中的作用。方法：回顾性分析935例患者行腹部螺旋CT三维重建的临床资料，采用容积再现(VR)、曲面重组(MPR)和最大密度投影(MIP)3种方法进行血管重建，总结RIPA的起源和分布对经导管动脉栓塞化疗(TACE)的指导意义。结果：935例进行右膈下动脉螺旋CT三维重建的病例均可成功显示膈下动脉起源(占100%)，其中发自于双侧膈下动脉共干者为163例(占17.4%)，单独发自于RIPA者为772例，其中发自于腹主动脉、腹腔动脉干、右侧肾及副肾动脉、胃左动脉、肠系膜上动脉和肝动脉分别为367(占39.3%)、320例(占34.2%)、196例(占21.0%)、27例(占2.9%)、11例(占1.1%)和14例(占1.5%)。RIPA参与原发性肝癌(HCC)供血者达12.5%(32/255)。结论：螺旋CT三维重建可在介入术前了解右膈下动脉的起源与分布，并判断有无肝癌侧枝供血，对于临床TACE具有指导意义。
목적：분석우측격하동맥(RIPA)재다층라선CT혈관삼유중건중적표현，탐사기해부여변이재간암개입치료중적작용。방법：회고성분석935례환자행복부라선CT삼유중건적림상자료，채용용적재현(VR)、곡면중조(MPR)화최대밀도투영(MIP)3충방법진행혈관중건，총결RIPA적기원화분포대경도관동맥전새화료(TACE)적지도의의。결과：935례진행우격하동맥라선CT삼유중건적병례균가성공현시격하동맥기원(점100%)，기중발자우쌍측격하동맥공간자위163례(점17.4%)，단독발자우RIPA자위772례，기중발자우복주동맥、복강동맥간、우측신급부신동맥、위좌동맥、장계막상동맥화간동맥분별위367(점39.3%)、320례(점34.2%)、196례(점21.0%)、27례(점2.9%)、11례(점1.1%)화14례(점1.5%)。RIPA삼여원발성간암(HCC)공혈자체12.5%(32/255)。결론：라선CT삼유중건가재개입술전료해우격하동맥적기원여분포，병판단유무간암측지공혈，대우림상TACE구유지도의의。
Objective:To analysis the anatomy and variations of the right inferior phrenic artery (RIPA) in 3D-MDCT reconstruction and discuss the application in interventional treatment of HCC. Methods:The origin and distribution of RIPAs in 935 cases(628 cases of hepatic cirrhosis, 255 cases of HCC, 52 cases of normal people) were analyzed retrospectively by using volume rendering (VR), multiplanar reconstruction (MPR) and maximum intensity projection (MIP) to summarize the applications before and after transcatheter arterial chemoembolization (TACE). Results: The RIPA origin was detected in all cases (sensitivity 100%). The RIPA and LPIA have the common trunk in 163 cases, and arise separately in other 772 cases. RIPAs originated from the aorta (39.3%), celiac trunk (34.2%), right renal artery or accessory renal artery (21.0%), left gastric artery (2.9%), superior mesenteric artery (1.1%) and hepatic artery (1.5%). Thirty-two of 255 cases demonstrate the supplement of HCC. Conclusion: 3D-MDCT reconstruction can be used to recognize the origin and distribution of RIPA and judge the extrahepatic collateral vessels by interventional radiologists before TACE.