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目的：研究经左锁骨下动脉入路插管对某些非正常型血管分布的肝癌患者在ＴＡＥ技术操作中的意义。方法：１０５例均为首次经股动脉插管未能超选择插管成功者。其中Ａ组，即腹腔动脉（ＣＡ）干长于２．５ｃｍ者５８例，Ｂ组即肝动脉开口于肠系膜上动脉（ＳＭＡ）者４０例，Ｃ组即开口于ＣＡ的肝总动脉已闭塞，由源于ＳＭＡ的胰十二指肠下动脉侧支供血者７例。经左锁骨中外１／３交点下２ｃｍ处向内上方向约３０°角穿刺左锁骨下动脉，用ｓｅｌｄｉｎｇｅｒ法把导管顺向引入肝固有动脉或侧支供血动脉，然后再行ＴＡＥ。结果：由于自上而下插管，易克服长ＣＡ或ＳＭＡ对导管短攀的反向力度，故１０５例均获超选择成功。结论：Ａ、Ｂ二组患者已占全部肝癌患者约４０％～５０％，熟悉经左锁骨下动脉途径插管对提高超选择技术有意义。
OBJECTIVE: To study the significance of TAE technique in patients with hepatocellular carcinoma with abnormal distribution of blood vessels through the left subclavian artery. METHODS: All 105 cases were successful for the first time. In group A, 58 cases of celiac artery (CA) were longer than 2.5 cm. In group B, 40 cases of hepatic artery were opened in superior mesenteric artery (SMA). In group C, the common hepatic artery that was open to CA was occluded. The SMA-derived pancreatic duodenal artery collateral blood supply in 7 cases. The left subclavian artery was punctured at an angle of about 30° 2 cm from the left and right 1/3 of the left middle clavicle and the third inward direction. The seldinger method was used to introduce the catheter into the proper hepatic artery or collateral artery, and then TAE was performed. RESULTS: Due to the intubation from top to bottom, it was easy to overcome the inverse strength of long CA or SMA catheter short-climb, so all 105 cases were successfully selected. Conclusion: Patients A and B have about 40% to 50% of all patients with HCC. Their familiarity with intubation through the left subclavian artery is of great significance in improving overselection techniques.