肝动脉化疗时暂时阻断胃十二指肠动脉的意义

Significance of temporary block of the gastroduodenal artery in hepatic artery chemotherapy

目的 评估暂时阻断胃十二指肠动脉行肝动脉化疗的意义。方法 4 0例原发性肝癌患者随机分成治疗组与对照组 ,每组 2 0例。治疗组将动脉导管置于胃十二指肠动脉 ,缓慢注入垂体后叶素 (2U min) ,暂时阻断胃十二指肠动脉 ,然后将导管退至肝总动脉化疗。对照组将动脉导管置于胃十二指肠动脉 ,缓慢注入生理盐水 10ml后将导管退至肝总动脉化疗。结果 治疗组患者均有一过性血压增高 ,增高幅度约 2 0～ 5 0mmHg不等 ,在 2 0～ 30min后血压恢复至正常 ,患者均能耐受 ,术后仅 2例出现上腹部疼痛 ,其他患者胃肠道反应轻微。对照组有 5例患者术中出现胃区不适或疼痛 ,9例术后有上腹部疼痛 ,其中有 2例出现重度疼痛 ,1例经胃镜证实为胃窦部糜烂。经统计分析 ,两组差异有显著性 (P <0 .0 2 5 )。术后上腹部疼痛相对危险度减少为 77.8% ,绝对危险度减少为35 .0 % ,需要治疗者为 2 .86人。治疗组与对照组恢复术前食欲水平的时间分别为 7.1± 1.37d和11.8± 2 .5 6d ,差异有显著性 (P <0 .0 1)。结论 肝动脉化疗前暂时阻断胃十二指肠动脉的手术方法简单易行、安全、有效 ,减少了肝动脉化疗的副反应 ,减轻了患者经济负担 ,可以作为肝动脉化疗的规范化术式推广。

Objective To evaluate the significance of temporary block of gastroduodenal artery in hepatic artery chemotherapy. Methods Forty patients were randomized into two groups with 20 in each. In the trial group, when the catheter was introduced into the gastroduodenal artery, pituitrin was infused slowly (2 U/min) till the gastroduodenal artery became blocked, then the catheter was pulled back to the common hepatic artery to start chemotherapy. In the control group, saline (10 ml) was infused slowly (4 ml/min) instead of pituitrin. ResultsIn the trial group, all patients had temporary increase of blood pressure ranging from 20 to 50 mm Hg, which was tolerated with most recovered in 20 to 30 minutes. Two patients had pain in the upper abdomen and others only had slight gastrointestinal discomfort. In the control group, epigastric upset or pain during operation was present in 5 patients. In 9 patients, upper abdominal pain after the operation was present which was serious in two. One of these two patients was confirmed as having gastric antrum erosion by gastroscopy. There was statistically significant difference in the upper abdomen pain in these two groups by Chi-square test (P<0.025). The relative and absolute risk reduction were 77.8% and 35.0% and the mean number of patients needed to treat was 2.86. The time of resuming preoperative appetite in the trial and control groups were 7.1±1.37 and 11.8±2.56 days, with the difference statistically significant (P<0.01).Conclusion Temporarily block of the gastroduodenal artery, being simple, safe, and effectively reducing patients′ untoward and finacial burden, is advised to be practiced in hepatic artery chemotherapy.