经锁骨下动脉穿刺介入治疗肝癌57例探讨

Subclavian artery puncture in interventional treatment of 57 cases of liver cancer

目的探讨经锁骨下动脉穿刺进行肝动脉栓塞治疗肝癌的效果及并发症。方法回顾性分析57例经锁骨下动脉穿刺行肝癌栓塞的方法及效果。结果 57例手术者锁骨下动脉穿刺成功者57例,肝动脉栓塞成功者57例,术后疼痛者57例,其中轻度不需要处理13例,疼痛稍重者29例,给予双氯灭痛栓治疗;疼痛较重者15例,给予强痛定或杜冷丁治疗。发热49例,其中<38.4℃15例,未予药物治疗;>38.5℃者34例,给予药物退热或物理降温;术后未发生严重感染、气胸、消化道出血、穿孔。患者术后随访48个月,1年生存率为78.9%(45/57);2年累计生存率为47.4%(27/57);3年累计生存率为28.1%(16/57);4年累计生存率为15.8(9/57)。57例患者未严格要求下肢制动及平卧。结论经锁骨下动脉穿刺介入治疗肝癌创伤小、术后不良反应轻、效果好。

Objective To investigate the effect and complications of subclavian artery puncture for transcatheter arterial em- bolization in the treatment of liver cancer. Methods The method and effect of subclavian artery puncture embolization on 57 ea- ses of liver cancer were retrospectively analyzed. Results All of the patients had successful subclavian artery puncture and he- patic artery embolization, 57 patients with postoperative pain, 13 cases of mild, 29 patients with slightly heavier pain, diclofenac sodium suppositories was given; 15 patients with more severe pain, fortanodyn or demerol was offered. Forty-nine cases had fe- ver, of which below 38.4 degrees in 15 cases, no drug was given; more than 38. 5 degrees in 34 cases, drug and physical cooling was given. There was no serious postoperative infections such as pneumothorax, bleeding, perforation of digestive tract. Postoper- ative follow-up of 48 months, the 1-year survival rate was 78.9% （45/57） ; 2-year cumulative survival rate was 47.4% （27/ 57 ） ; 3-year cumulative survival rate was 28. 1% （16/57 ） ; 4-year cumulative survival rate was 15.8 （9/57）. The 57 patients were not strict with leg brake and prostrate. Conclusion The subclavian artery puncture in interventional treatment of liver canc- er has little postoperative trauma, slight side effects, and is effective.