经远桡动脉入路HAIC治疗肝肿瘤的安全性和舒适性研究

Safety and Comfort Analysis of Distal Transradial Access for Hepatic Artery Infusion Chemotherapy in the Treatment of Liver Cancer

【目的】评价经远桡动脉入路对肝肿瘤患者行肝动脉持续灌注化疗(HAIC)的安全性和舒适性。【方法】纳入中山大学附属第一医院放射介入科行经远桡动脉入路进行HAIC的肝肿瘤患者,患者进行1次股动脉入路和1次远桡动脉入路穿刺置管进行自身交叉对照。患者留置导管于肝动脉内行FOLFOX4方案持续动脉灌注化疗。使用生活质量评分量表比较患者远桡动脉入路和股动脉入路的生活质量评分以及记录手术相关并发症。【结果】共纳入患者18例肝肿瘤患者,其中9例先进行股动脉入路后进行远桡动脉入路HAIC,其余9例则先远桡入路再进行股动脉入路HAIC。dTRA期间,穿刺点血肿2例,穿刺点持续疼痛3例,左手掌麻木1例,均为1~2级手术相关的不良事件。没有发生3~4级手术相关的不良事件。术后超声检查显示近端桡动脉均通畅。dTRA和TFA之间的穿刺时间差异有统计学意义(4分vs.3分,P<0.05)。然而,dTRA的生活质量评分均优于TFA。患者更倾向选择dTRA(7.89 vs.2.72,P<0.001)。dTRA的压迫止血时间比TFA更短(2 h vs.7 h,P<0.05)。【结论】经远桡动脉入路安全可耐受,有利于肝肿瘤患者行持续动脉灌注化疗期间的生活质量和舒适度提升。

【Objective】To evaluate the safety and comfort of hepatic artery infusion chemotherapy(HAIC)via distal transradial access(dTRA)in patients with liver cancer.【Methods】Patients with advanced liver cancer who received HAIC via dTRA or transfemoral access(TFA)at the Department of Interventional Radiology,the First Affiliated Hospital of Sun Yat-sen University,were enrolled.The patients underwent dTRA or TFA for onetime and crossed-over subsequently.The patients received HAIC using FOLFOX4 regimen.Postcatheterization questionaire was used to compare the effects of the two vessel accesses on patients’quality of life.Procedure-related adverse events were also recorded.【Results】Among the 18 cases enrolled for HAIC,9 underwent crossover from dTRA to TFA and the the remaining 9 from TFA to dTRA.During HAIC via dTRA,we only found grade 1 or grade 2 procedure-related adverse events such as 2 access site hematoma,3 persistent pain at access site and 1 left palm numbness.No grade 3 or grade 4 procedure-related adverse event was found.Post dTRA ultrasound revealed no proximal radial artery occlusion.Significant difference in catheterization time between dTRA and TFA accesses was found(4 min vs.3 min,P<0.05).All comfort scores were higher with dTRA as compared to TFA and patients preferred dTRA(7.89 vs.2.72,P<0.001).The compression time for dTRA access was significantly shorter than TFA access(2 h vs.7 h,P<0.05).【Conclusions】dTRA approach is safe and tolerable,which is beneficial to improve the quality of life and comfort of patients with liver cancer when undergoing HAIC.