微导管在肝动脉化疗栓塞治疗原发性肝癌的临床应用

Clinical Application of Microcatheter in Transcatheter Arterial Chemoembolization Therapy for Primary Liver Cancer

目的 评价 3.0F微导管在肝动脉化疗栓塞治疗原发性肝癌中的临床应用价值 ,讨论其操作技术和使用适应证。资料与方法 32例原发性肝癌患者采用 3.0FSP导管进行化疗栓塞治疗。使用SP导管的原因为 :肿瘤肝外侧支供血 (n =9) ;肿瘤供养血管细小需超选择 (n =16 ) ;腹腔干和肝动脉解剖变异 (n =6 ) ;肝动脉痉挛 (n =1)。结果 32例患者共使用SP导管 4 2次 ,操作成功 39次 ,失败 3次 ,成功率为 92 .9%。治疗后AFP下降 >5 0 %者 2 7例 (84 .4 % ) ,肿瘤病灶缩小 >5 0 %者 8例 (2 5 % ) ,略有缩小者 16例 (5 0 % ) ,其余患者肿瘤无明显变化。 2例成功进行肿瘤内科性亚肝段切除。全部患者术后均无严重并发症。结论 微导管操作简单、方便 ,超选择成功率高 ,特别适用于肿瘤供血动脉严重狭窄、细小 ,走行迂曲和容易痉挛的患者 。

Objective To evaluate 3.0F microcatheter in clinical transcatheter arterial chemoembolization therapy (TACE) for primary liver cancer, and to discuss the manipulative technique and indications of using microcatheter. Materials and Methods Using emulsion of Lipiodol with antineoplastic medicine as embolic agents, TACE, using a 3.0F SP microcatheter, was performed in 32 patients of primary liver cancer. The reason to use a microcatheter in this group was as follows. (1) The blood supply of the tumor was from extrahepatic collaterals (n=9). (2) The tumor feeding artery was so small that super selective catheterization was needed (n=16). (3) Anatomic variations of celiac and common hepatic artery (n=6). (4) hepatic artery spasm (n=1).Results The microcatheter was used 42 times in 32 patients. The catheterization was successful in 39 procedures (92.9%) and failure in 3. After therapy, serum AFP reduction over 50% was noted in 27 patients (84.4%), while tumor size reduced over 50% in 8 (25%) and less than 50% in 16 (50%). Successful internal sub segmental hepatectomy was carried out in 2 patients. No serious complication occurred in all patients.Conclusion The manipulation of microcatheter is simple and easy, with a high successful rate. The microcatheter technique has great value in TACE therapy for primary liver cancer, especially for patients with small, severely narrowed, tortuous or easily spastic tumor feeding arteries.