DOI：10-16016/j.1000-5404.201502002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罗家敏，罗小平，刘曦，何明菊，杨伟(重庆医科大学附属第二医院放射科，重庆400010)［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(rightinferiorphrenicartery,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。方法冋顾性分析我院161例原发性肝癌首次行插管化疗栓塞时即行右侧嗝下动脉造影者的MRI或CT、DSA资料，按肿瘤是否有RIPA参与供血分RIPA纟H.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冋归分析。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二0.034)、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VTT段且无完蔡包膜者，RIPA参与肿瘤供血的机会增加。［关键词］原发性肝癌；经动脉插管化疗栓塞；右侧嗝下动脉；肿瘤血供；影响因素［中图法分类号］R735.7；R453.9；R322.1+21［文献标志码］AAnalysisaboutcausativefactorsofRIPAparticipatinginthebloodsupplyofPLCatinitialTACEsessionLuoJiamin,LuoXiaoping,LiuXi,HeMingju,YangWei(DepartmentofRadiology,SecondAffiliatedHospital,ChongqingMedicalUniversily,Chongqing,400010,China)[Abstract]ObjectiveAnalyzethecaustitivefactorsofRIPAparticipatinginthebloodsupplyofPLCatinitialTACEsession,soastoprovideimportantreferenceforjudgingwhetherthereisbloodsupplyfromRIPAbeforeTACE.MethodsRetrospectivelyanalyzetheradiographicmaterialsof161patientswithPLCwhounderwentRIPAangiographyatthefirstTACEtreatmentinourhospital,wedividedallpatientsintoRIPAgroupandNRIPAgroupaccordingtowhetherRIPAparticipatesintumorbloodsupplyornot.Evaluatetumorsizejocationandtumorcapsulebetweenthetwogroups,Univariateandmultivariateanalyseswereperformedinthisstudy.Results77cases(47.8%)werefoundedtohavethebloodsupplyfromRIPAatinitialTACEsession,Univariateanalysisshowedthattumorsize(P<0.01),involvingthelivercapsule(P=0.034),tumorcapsule(P<0.01)andtumor'sliversegment(P<0.01)weresignificantlyassociatedwiththebloodsupplyfromRIPAinPLCatinitialTACEsession,Multiplelogisticregressionanalysisshowedthattheclassificationoftumorsize,tumor^sliversegmentandtumorcapsulewereindependentpredictivefactorsofwhetherthePLChasbloodsupplyfromRIPAornotatinitialTACEsession.ConclusionWhenPLCislocatedinthebareareaordirectlybeneaththediaphragmandofmassivetype,especiallylocatedinsegment7andwithoutaintactcapsule,TheopportunityofRIPAparticipatinginbloodsupplyofPLCatinitialTACEsessionincreases・[Keywords]primarylivercancer;TACE；rightinferiorphrenicartery；bloodsupply;thecausativefactorsCorrespondingauthor:LuoXiaoping,E-mail:luoxiaoping123@126.com［通信作者］罗小平.E-mail:luoxiaoping123@126.com原发性肝癌(primarylivercancer,PLC,简称肝癌)因其生物学特性等原因，往往在发现时己无法进行外科切除。H前经动脉插管化疗栓塞(transcatheterarterialchemoembo1ization,TACE)治疗是不可切除肝癌的首选治疗方法巴而影响TACE疗效的关键在于完全栓塞肿瘤血供⑵。肝癌的滋养动脉多丁分复杂，除肝动脉外，常并存多种肝外侧枝，如膈下动脉、内乳动脉、肋间动脉、网膜动脉等,其中以RIPA最常见"I既往研究发现，多次TACE治疗易引起肝动脉狭窄闭塞而增加RIPA参与肿瘤供血的概率，首次TACE治疗时，肝动脉多通畅，此时RIPA参与肿瘤供血的原因被认为主要与肿瘤的位置、大小有关^。我们在临...