肝癌治疗术中肝动脉插管途径的选择

Selection of pathways in hepatic arterial cannulation in liver cancer operation

目的探讨肝癌治疗术中肝动脉插管途径的选择。方法回顾性分析我们近5年来在手术中经肝动脉插管对100例肝癌病人进行栓塞化疗的临床资料。结果经导管注入美蓝证实,有95例肝脏全部染色,另5例仅见约3/4的肝脏被染色。成功率高达95%。术后发生剧烈腹痛14例,胰头出血、坏死1例,异位栓塞6例。发生导管移位9例。死亡2例。经胃网膜右动脉插管者,其术后导管移位率高达37%。经胃十二指肠动脉插管病人的术后死亡率高达20%。结论为预防肝癌肝内广泛转移,肝动脉插管应以肝动脉能覆盖全肝为原则。经胃右动脉插管最为方便、可靠,并发症少;经胃网膜右动脉插管者并发症最多见;经胃十二指肠动脉插管者并发症最为严重。

Objective To explore the selection of pathways in hepatic arterial cannulation in liver cancer operation. Methods 100 cases with hepatic cancer treated by hepatic arterial cannulation chemoembolization in operation within 5 years were retrospectively analyzed. Results 95% of liver were totally dyed by ethylene blue. 1/4 of liver were not dyed in 5 cases. Sever abdominal pain occurred in 14 cases; pancreatic necrosis in one; ectopia embolism in 6 cases;2 of them died of hepatic dysfunction and necrosis. Cannulation site changed in 9 patients through right gastric-momentum artery. Mortality rate of patients through gastric-duodenum artery was about 20%. Conclusion Covering all liver was the main principle for hepatic artery cannulation. The best convenient and safest pathway was through right gastric artery. Most serious complications occurred when the pathway was through right gastric-momentum artery. Through gastric-duodenum artery might cause critical postoperative complication.