CAJ | 학술논문

目的探讨右膈下动脉分支参与原发性肝细胞癌供血时的血管造影表现及其影响因素.方法收集我院2009至2013年行经动脉插管栓塞治疗时造影发现右膈下动脉(RIPA)参与供血之原发性肝癌病例的临床及影像资料,整理RIPA分支参与肿瘤供血时的影像特征,并统计分析是否初次治疗、肿瘤大小、肿瘤生长方式、生长位置等因素与RIPA分支参与供血的相关性.据资料不同分别采用x2检验、t检验、Fisher确切概率法及秩和检验进行统计学分析.结果共收集患者140例,初次治疗组(A组)63例,再/多次治疗R组(B组)77例,两组间RIPA各分支供血情况(P=0.645)及单次治疗RIPA供血分支数(P=0.576)差异无统计学意义.A组中不同大小的肿瘤之间单次治疗RIPA供血分支数差异有统计学意义(P=0.047);病灶部分或全部位于肝裸区者占50.8％ (32/63),其中RIPA后支参与供血者占81.2％(26/32).位于不同位置的肿瘤,RIPA各分支所占供血比例不同:前、外侧支参与S7、S8段肿瘤分别为91.7％ (55/60)、95.1％ (98/103);后支参与S6、S7段供血为92.5％ (98/106);膈脚支参与S4、8段病灶供血为85％ (17/20);右肾上腺上动脉参与S6段病灶比例为71.4％ (10/14),各供血分支造影图像各有特征.结论 RIPA各分支参与供血概率及数量与是否初治无明显关系,其与肿瘤所在位置、大小、是否侵犯包膜密切相关.单次治疗参与供血RIPA分支数与肿瘤大小呈正相关,RIPA各分支供血概率与病灶所处位置有关,且造影图像各有特征.
목적 탐토우격하동맥분지삼여원발성간세포암공혈시적혈관조영표현급기영향인소.방법 수집아원2009지2013년행경동맥삽관전새치료시조영발현우격하동맥(RIPA)삼여공혈지원발성간암병례적림상급영상자료,정리RIPA분지삼여종류공혈시적영상특정,병통계분석시부초차치료、종류대소、종류생장방식、생장위치등인소여RIPA분지삼여공혈적상관성.거자료불동분별채용x2검험、t검험、Fisher학절개솔법급질화검험진행통계학분석.결과 공수집환자140례,초차치료조(A조)63례,재/다차치료R조(B조)77례,량조간RIPA각분지공혈정황(P=0.645)급단차치료RIPA공혈분지수(P=0.576)차이무통계학의의.A조중불동대소적종류지간단차치료RIPA공혈분지수차이유통계학의의(P=0.047);병조부분혹전부위우간라구자점50.8％ (32/63),기중RIPA후지삼여공혈자점81.2％(26/32).위우불동위치적종류,RIPA각분지소점공혈비례불동:전、외측지삼여S7、S8단종류분별위91.7％ (55/60)、95.1％ (98/103);후지삼여S6、S7단공혈위92.5％ (98/106);격각지삼여S4、8단병조공혈위85％ (17/20);우신상선상동맥삼여S6단병조비례위71.4％ (10/14),각공혈분지조영도상각유특정.결론 RIPA각분지삼여공혈개솔급수량여시부초치무명현관계,기여종류소재위치、대소、시부침범포막밀절상관.단차치료삼여공혈RIPA분지수여종류대소정정상관,RIPA각분지공혈개솔여병조소처위치유관,차조영도상각유특정.
Objective To analyze the angiographic features and factors related to the blood supply from right inferior phrenic artery (RIPA) branches in hepatocellular carcinoma (HCC).Methods Angiography images of blood supply from RIPA branches and clinical data from patients with HCC who had undergone tmnscatheter arterial chemoembolization in our hospital between 2009 and 2013 were collected for retrospective analysis.Angiographic features of the RIPA branches were assessed for correlation between treatment number, growth pattern, size, tumor location, and rates of blood supplying RIPA branches.Statistical analyses were carried out using chi-square test, t-test, Fisher's exact test and rank sum test.Results The 140 patients included in the analysis were grouped according to primary HCC (n =63;group A) and recurrent HCC (n =77;group B) and no statistically significant differences were found between the two groups for incidence of each nutrient branch or total number of nutrient branches.In group A, tumor size was associated with number of nutrient branches (P =0.047).There were 32 cases with HCC lesions in the bare area of the liver, and among those 26 of the cases were supplied by the posterior branch of RIPA.Each branch of RIPA showed greater firequency for particular blood supply areas;the anterior branch (n =55) and lateral branch (n =98) fed tumor lesions in segments 7 and 8, the posterior branch (n =98) fed tumor lesions in segments 6 and 7, and the supra-renal branch (n =10) fed tumor lesions in segment 6.The diaphragmatic branch always fed HCC partly located in segments 4 and 8 (n =17).Unique features were present on the digitally subtracted angiography (DSA) image for each nutrient branch and may be useful for distinguishing in clinical examination.Conclusion Cases of primary HCC and recurrent HCC are not distinguishable by incidence of each nutrient branch or total numbers of the nutrient branches.However, tumor size is related to the number of RIPA nutrient branches, and each RIPA nutrient branch shows a dominant preference for certain blood supply areas, with unique features on DSA.