Seki H, Kimura M, Yoshimura N, Yamamoto S, Ozaki T, Sakai K
Department of Radiology, Niigata University School of Medicine, Japan.
Clin Radiol. 1999 Apr;54(4):221-7. doi: 10.1016/s0009-9260(99)91155-8.
To assess the factors affecting patency of the hepatic artery during hepatic arterial infusion chemotherapy (HAIC) with an implantable port system inserted percutaneously.
Ninety patients with malignant hepatic tumours were given HAIC using percutaneous catheter placement. An end-hole catheter was inserted into the hepatic artery (conventional method) in 41 patients. An end-closed and side-hole catheter was used in 49 patients, in which the catheter tip was fixed in the gastroduodenal artery and the side hole was placed in the common hepatic artery (fixed catheter-tip method). The patency of the hepatic artery was evaluated with computed tomography (CT) arteriography using the implantable port system and angiography. Then, the factors affecting hepatic arterial patency were analysed.
Hepatic arterial occlusion was observed in 15 patients (17%). The overall patency of the hepatic artery was 86.9%, 78.4% and 51.5% at 6 months, 1 year and 2 years, respectively. The patency rate of the hepatic artery was significantly higher in patients with catheter placement using fixed catheter-tip method than those using conventional method (P = 0.01), and in patients without transcatheter arterial chemoembolization (TACE) prior to catheter placement than those with prior TACE (P = 0.01). When the variables affecting patency of the hepatic artery were studied together by multivariate analyses, the important factors were the method of catheter placement and the presence or absence of prior TACE.
We consider that it is important for long-term patency of the hepatic artery during HAIC to use fixed catheter-tip method for percutaneous catheter placement instead of conventional method, and to select patients without prior TACE.
评估经皮插入植入式端口系统进行肝动脉灌注化疗（HAIC）期间影响肝动脉通畅性的因素。
90例恶性肝肿瘤患者接受经皮导管置入的HAIC治疗。41例患者将端孔导管插入肝动脉（传统方法）。49例患者使用端封闭侧孔导管，其中导管尖端固定于胃十二指肠动脉，侧孔置于肝总动脉（固定导管尖端法）。使用植入式端口系统通过计算机断层扫描（CT）血管造影和血管造影评估肝动脉的通畅性。然后，分析影响肝动脉通畅性的因素。
15例患者（17%）观察到肝动脉闭塞。肝动脉的总体通畅率在6个月、1年和2年时分别为86.9%、78.4%和51.5%。采用固定导管尖端法进行导管置入的患者肝动脉通畅率显著高于采用传统方法的患者（P = 0.01），且在导管置入前未进行经动脉化疗栓塞（TACE）的患者中高于有TACE史的患者（P = 0.01）。通过多因素分析共同研究影响肝动脉通畅性变量时，重要因素为导管置入方法和是否有TACE史。
我们认为，在HAIC期间，为实现肝动脉的长期通畅，经皮导管置入采用固定导管尖端法而非传统方法，并选择无TACE史的患者很重要。
