目的:评价经膈下动脉介入治疗肝细胞癌的影像学表现及并发症。
方法:25例患者(19例男性;年龄范围,57-89岁)在这项研究中进行了回顾性审查。在所有程序中,在右膈下动脉(n=39)或左膈下动脉(n=1)选择性插入微导管,经导管动脉化疗栓塞术(n=39)或经导管动脉栓塞术(n=1)。回顾了影像学发现和患者图,和并发症,直到出院时间(中位住院时间,10.5天;范围,3-21)进行了评估。
结果:在血管造影或计算机断层扫描期间,在39例手术中,有8例可见从右膈下动脉到肺动脉的侧支循环(7例,28%)。在其中七个程序中,在手术后(术后计算机断层扫描)在肺动脉或胸膜中未增强的计算机断层扫描中发现了碘油沉积,在六个程序中,在1周的随访计算机断层扫描中,发现沉积的碘油扩散到邻近的肺野.在18例手术中,沿心脏右缘可见右膈下动脉分支,在四个手术的术后计算机断层扫描中,沿心脏的右缘观察到了碘油沉积。39例右膈下动脉介入手术中有21例发生并发症(53%):18例肩痛(45%),14例胸腔积液(35%),基底性肺不张11例(28%),阵发性房颤2例(5%),咯血1例(3%)。在14个程序中(35.9%),在后续的计算机断层扫描检查中可以看到胸腔积液,其中11例(28.2%)也表现为基底性肺不张。然而,在术后计算机断层扫描中,只有3例胸腔积液手术显示碘油沉积。1例患者经右膈下动脉两次行经导管动脉化疗栓塞,两种手术后均发生心房颤动.
结论:肝动脉化疗栓塞术或经膈下动脉栓塞术治疗肝细胞癌相对安全。肩痛是最常见的并发症,只需要保守治疗。血管造影显示,胸腔积液或基底肺不张与右膈下动脉至肺动脉的侧支循环之间无明显联系。血管造影或术后计算机断层扫描。
OBJECTIVE: To evaluate imaging findings and complications from transcatheter interventional treatment of hepatocellular carcinoma via the inferior phrenic arteries.
METHODS: 40 procedures in 25 patients (19 men; age range, 57-89 years) were retrospectively reviewed in this study. In all procedures, a micro-catheter was selectively inserted in the right inferior phrenic artery (n = 39) or left inferior phrenic artery (n = 1), and transcatheter arterial chemoembolization (n = 39) or transcatheter arterial embolization (n = 1) was performed. Imaging findings and patient charts were reviewed, and complications until time of discharge (median hospitalization period, 10.5 days; range, 3-21) were assessed.
RESULTS: On angiography or computed tomography during angiography, collateral circulation from the right inferior phrenic artery to the pulmonary artery was seen in eight of 39 procedures (seven patients, 28%). In seven of these procedures, Lipiodol deposition was seen on the unenhanced computed tomography just after the procedure (post-procedure computed tomography) in the pulmonary arteries or pleura, and in six procedures, the deposited Lipiodol was noted to have spread into adjacent lung fields on the one week follow-up computed tomography. Branches of the right inferior phrenic artery were seen along the right margin of the heart in 18 procedures, and Lipiodol deposition was seen along the right margin of the heart on post-procedure computed tomography in four procedures. Complications occurred in 21 of 39 procedures of right inferior phrenic artery intervention (53%): shoulder pain in 18 (45%), pleural effusion in 14 (35%), basal atelectasis in 11 (28%), paroxysmal atrial fibrillation in two (5%) and hemoptysis in one (3%). In 14 procedures (35.9%), pleural effusion was seen on follow-up computed tomography examinations, and 11 (28.2%) of these procedures also showed basal atelectasis. However, only three procedures with pleural effusion showed Lipiodol deposition on the post-procedure computed tomography. In one patient who underwent transcatheter arterial chemoembolization twice via the right inferior phrenic artery, atrial fibrillation occurred after both procedures.
CONCLUSIONS: Transcatheter arterial chemoembolization or transcatheter arterial embolization via the inferior phrenic artery in patients with hepatocellular carcinoma was relatively safe. Shoulder pain was the most frequent complication, and required only conservative treatment. There was no clear connection between pleural effusion or basal atelectasis and collateral circulation from the right inferior phrenic artery to the pulmonary artery depicted on angiography, computed tomography during angiography or post-procedure computed tomography.