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目的探讨肝动脉化疗栓塞(TACE)时肝动脉单向活瓣患者的插管技术。方法收集2000—2011年在上海中山医院行TACE中存在肝动脉单向活瓣的患者128例,其中肝细胞癌110例,胆管细胞癌3例,转移性肝癌15例。90例(70.3%,90/128)患者出现肝动脉单向活瓣前曾行TACE 2~5次,38例(29.7%,38/128)患者为首次介入治疗患者。肝动脉插管采用微导管同轴导管技术经肠系膜上动脉和腹腔动脉途径进行,分别比较经这2种途径插管的成功率和平均透视时间。结果 128例患者共进行了337次超选择性肝动脉插管(平均每例2.6次),成功337次,成功率为100%。337次插管中经腹腔动脉途径插管148次(43.9%,148/337),平均透视时间3.2(1~6)min;经肠系膜上动脉途径插管189次(56.1%,189/337),平均透视时间15.3(5~40)min。经腹腔动脉途径插管的平均透视时间明显少于经肠系膜上动脉途径的平均透视时间(P<0.05)。结论对肝动脉单向活瓣的患者,可采用同轴微导管技术经肠系膜上动脉和腹腔动脉2个途径进行超选择性肝动脉插管。与肠系膜上动脉途径相比较,经腹腔动脉途径插管操作更加简单,透视时间明显缩短。
Objective To investigate the intubation technique of hepatic artery one-way valve in patients undergoing hepatic arterial chemoembolization (TACE). Methods A total of 128 patients with hepatic artery unilateral valve in TACE at Zhongshan Hospital of Shanghai from 2000 to 2011 were collected, including 110 hepatocellular carcinoma, 3 cholangiocarcinoma and 15 metastatic liver cancer. Ninety patients (70.3%, 90/128) had TACE 2 to 5 times before the unilateral hepatic artery occlusion. Thirty-eight patients (29.7%, 38/128) were involved in the first interventional therapy. Hepatic artery catheterization using microcatheter coaxial catheter technology via the superior mesenteric artery and celiac artery approach, respectively, by these two ways to compare the success rate and the average fluoroscopy time. Results A total of 337 patients undergoing selective hepatic artery cannulation (average 2.6 cases per case) were performed in 128 patients, with a success of 337 and a success rate of 100%. The intubation was performed by intraperitoneal route intubation for 148 times (43.9%, 148/337) in 337 cannulas, the average fluoroscopy time was 3.2 (1-6 min), the superior mesenteric artery catheterization was 189 times (56.1%, 189/337) , The average time of 15.3 (5 ~ 40) min. The mean fluoroscopy time of intubation through the celiac artery was significantly less than that of the superior mesenteric artery (P <0.05). Conclusion For the patients with unilateral hepatic artery surgery, the use of coaxial microcatheter can be super-selective hepatic artery cannulation via the superior mesenteric artery and celiac artery. Compared with the superior mesenteric artery approach, intubation through the celiac artery is easier and the fluoroscopy time is significantly shorter.