Extrahepatic Arterial Blood Supply Of Primary Hepatic Carcinoma And The Clinical Therapy

Objective Observing the types of extrahepatic arteries to the primary hepatic carcinoma and discussing the classification, common regularity of blood supply and the clinical significance to the treatment.Methods Retrospectively analyzed DSA findings of the patients treated by transcatheter arterial chemoembolism (TACE) in our department from Mar 1998 to Oct 2006. Observed whether there was extrahepatic arterial blood supply, and classified it into different types, and then analyzed its regularity and the instructive significance to the treatment of primary hepatic carcinoma and other hepatic diseases. Results There were 215 extrahepatic arteries in 185 cases of primary hepatic carcinoma out of 2578 cases, We divided them into three types: I, 130 of 215 pieces were variant hepatic artery blood supply, accounting 60.47%, 15 of 215 pieces (6.98%) were replaced left hepatic arteries, 13 of 215 pieces (6.05%) were accessory left hepatic arteries, 71 of 215 pieces (33.02%) were replaced right hepatic arteries, 14 of 215 pieces (6.51%) were accessory right hepatic arteries, 16 of 215 pieces (7.44%) were replaced common hepatic arteries; II, 35 of 215 pieces were collateral blood supply with hepatic arteries unobstructed, accounting 16.28%, omental artery and right inferior phrenic artery were most common, accounting 5.12% (11/215) and 4.19% (9/215) respectively;III, 50 of 215 pieces were collateral blood supply with the hepatic arteries occluded or narrowed, accounting 23.26%, gastroduoden artery and omental artery were most common, accounting 6.51% (14/215) and 5.12% (11/215) respectively. The last two types were non-hepatic arteries. There were multiple extrahepatic arteries in 24 of 185 cases, accounting 12.97%, Among these cases, 20 cases had 2 extrahepatic arteries, 2 cases had 3 extrahepatic arteries and 2 cases had 4 extrahepatic arteries. Three types had significant difference with the numbers of TACE: The first type were mostly found at the first time of TACE, the second and the third types were mostly found at the second and the following time of TACE, and there were statistical significance (the values of P were 0.0000 < 0.05, 0.0186 < 0.05, 0.0000 < 0.05). There was significant difference between the types of non-hepatic artery supply and obstruction of hepatic artery. Among these types, right inferior phrenic artery and collateral vessels of gastroduoden artery had statistical significance (The values of P were 0.0006 , 0.05, 0.0053 < 0.05), It was to say that right inferior adrenal artery participated the blood supply of tumor mostly when the hepatic arteries were unobstructed, while collateral vessels of gastroduoden artery participated the blood supply of tumor mostly when the hepatic arteries were obstructed or narrowed.Conclusion There are variable types of extrahepatic arterial blood supply in primary hepatic carcinoma, with the improvement and popularity of TACE, more and more new types are discovered, and its classification is also variable. Three classifications is a brand-new classifying method, and it is more succinct and distinct. Three are different features with different types of blood supply, which has instructive significance in analyzing the relationship between the types and the numbers of TACE and the obstruction of hepatic arteries. Study of the exrtahepatic blood supply in primary hepatic carcinoma can enhance the therapeutic effect of TACE, reduce the complications of TACE and instruct the operations on liver, the preoperative evaluation and manipulation in operation of orthotopic liver transplantation, the comprehensive therapy of hepatoma and clinical treatment of other hepatic disease.