经桡动脉途径、CBCT三维血管重建辅助的精细TACE治疗原发性肝癌:附124例报道

Precision TACE assisted by radial artery approach and CBCT three-dimensional vascular reconstruction in the treatment of primary liver cancer:report of 124 cases

目的探讨经桡动脉途径、锥形束CT(cone beam computed tomography,CBCT)三维血管重建辅助的精细经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗原发性肝癌的安全性和可行性。方法回顾性收集2018年5月至2019年12月期间于笔者所在医院经桡动脉途径进行精细TACE治疗的124例原发性肝癌患者的临床资料。结果124例患者中,118例患者经左侧桡动脉途径穿刺成功并完成TACE手术,手术时间(109.57±31.32)min,术后住院时间的中位数为3 d。1例患者因慢性肾功能衰竭、术前左侧肱动静脉穿刺置管而改用右侧桡动脉途径完成TACE,手术时间119 min,术后住院5 d后好转出院。1例患者左侧桡动脉穿刺成功后因前臂动脉成袢扭曲,导丝导管未能通过而改用右侧股动脉完成TACE,手术时间123 min,术后住院4 d后好转出院。4例患者因桡动脉穿刺不成功而改用右侧股动脉途径完成手术,手术时间(111.66±32.77)min,术后住院时间的中位数为3 d。其中1例患者最多连续5次成功完成经桡动脉途径的TACE。所有患者均在CBCT三维血管重建辅助下完成超选择插管的精细TACE。术后患者均未发生血管损伤闭塞、尿潴留、皮下出血等并发症。结论经桡动脉途径实施精细TACE是安全有效的,可多次重复,并发症少,患者舒适度高,可作为TACE的常规途径之一。

Objective To investigate the safety and feasibility of transcatheter arterial chemoembolization(TACE)assisted by transradial approach and cone beam computed tomography(CBCT)three-dimensional vascular reconstruction in the treatment of primary liver cancer.Methods The clinical data of 124 patients with primary liver cancer who underwent precision TACE via radial artery in our hospital from May 2018 to December 2019 were retrospectively collected.Results Among the 124 patients,118 patients were successfully punctured through the left radial artery and completed the TACE operation.The operation time was(109.57±31.32)min,and the median of postoperative hospitalization was 3 d.One patient changed to the right radial artery to complete TACE due to chronic renal failure and left brachial artery and vein puncture and catheterization before operation.The operation time was 119 minutes,and the patient was discharged after 5 days of hospitalization.After successful puncture of the left radial artery in one patient,the forearm artery was twisted into a loop and the guide wire catheter failed to pass,and the right femoral artery was used to complete TACE.The operation time was 123 minutes,and the patient was discharged after 4 days of improvement.The radial artery puncture was unsuccessful in four patients,and the right femoral artery approach was used to complete the operation;the operation time was(111.66±32.77)min,and the median of postoperative hospitalization was 3 d.One of the patients successfully completed up to 5 consecutive TACE via the radial artery.All patients underwent precision TACE with superselective cannulation assisted by CBCT three-dimensional vascular reconstruction.No vascular injury andocclusion,urinary retention,subcutaneous hemorrhage,and other complications occurred in all patients.Conclusions Trans-radial arterial precision TACE is safe and effective,which can be repeated many times and has few complications and high patient comfort.It can be used as one of the routine approaches of TACE.