经皮导管药盒系统置入术在肝转移瘤治疗中的应用(附54例分析)

Application of Percuaneous port -catheter system implantation in the management of liver metastases

评价经左锁骨下动脉穿刺导管药盒系统植人术在肝转移瘤治疗中的应用。材料与方法５４例肝转移瘤，其中来源于胃肠道转移的４０例，来源于其它脏器转移１４例。行经皮左锁骨下动脉穿刺导管药盒系统植人术。术后经导管药盒系统每月一次灌注碘油化疗药物乳剂或化疗药物灌注。结果导管药盒系统植人术技术成功率１００％。生存期：６月生存率为７８％，１年生存率为５７％，２年生存率为对．４％，３年生存率为１８％。术后１－３月ＣＴ或Ｂ超复查，肿瘤体积缩小大于５０％者占３３．３％，肿瘤体积缩小小于５０％者占３８％，无变化者占门％，增大者占１１％。手术有关并发症有：少量气胸１例，左锁骨下区皮下血肿１例，靶动脉闭塞１例。２例导管移位者经再次插管调整导管于靶动脉。导管阻塞治疗失败者１例，拔除导管药盒系统。结论经皮导管药盒系统植人术适用于肝转移瘤的长期动脉内灌注化疗和碘化油化疗药物乳剂栓塞治疗，疗效满意，并发症少而轻，值得推广应用。

Aim To evaluate the efficiency of port - catheter system (PCS) implantation in the treatment of livermetastases .Methods Pereutaneous Punctare of subclavian altery and PCS implantation were carried out in 54 patients wilhliver metastases from gastrointestinal tract (n = 40) and other organs (n = 14). All Patients were treated with intraarterialchemotherapy and/or chemoelhbolization with anticancer aunts and lipiodol emulsion via PCS per months. Rasults: The technique success rate was 100%. The 0. 5 -, 1-,2 - and 3 - year survival rate were 78%,57%,31 % and 17%. The shrinkage of tumor more than 50% in diameter was detected in 33% cases by CT or B - mode ultrasound, and less than 50% in37%. No change was found in 17%cases and the enlargement of tumor in 12% cases. The complications related to the techniqUe included pneumothorax (n = 1 ), helnatolna (n = 1 ), infection (n = I ). FI were cured with no severe complications. AfterPCS implatation, dislodgement of indwelling catheter tip was occured in 2 cases with the miglated catheter tips reinserted intothe target axteries, and occlusion of target artery was occurred in I case with PCS pulled out. COnclusion it is believed thatpercutaneous PCS implatation be a effective way of long-term intraarterial chemotherapy and /or chemoelnbolization with anticancer agents and lipiedol emulsion for treating liver metastases.