Aldrighetti Luca, Arru Marcella, Angeli Enzo, Venturini Massimo, Salvioni Marco, Ronzoni Monica, Caterini Roberto, Ferla Gianfranco
Department of Surgery, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
Hepatogastroenterology. 2002 Mar-Apr;49(44):513-7.
BACKGROUND/AIMS: Intra-arterial hepatic chemotherapy based on floxuridine infusion is an effective treatment for hepatic metastases from colorectal cancer. The aim of the present study is the comparative analysis of surgical and percutaneous transaxillary approaches to implant a catheter into the hepatic artery for intra-arterial hepatic chemotherapy with floxuridine.
Fifty-six patients received an arterial device for intra-arterial hepatic chemotherapy. Twenty-eight patients (LPT group) underwent laparotomy to implant the catheter into the hepatic artery, the other 28 patients (PCT group) received a percutaneous catheter into the hepatic artery through a transaxillary percutaneous access. Safety and efficacy of surgical and percutaneous transaxillary approaches were comparatively analyzed in terms of number of intra-arterial hepatic chemotherapy cycles administered, device-related complications causing suppression of intra-arterial hepatic chemotherapy, and biological costs of the procedures.
Mean postoperative hospitalization was 8.2 +/- 2.2 days in the LPT group and 1.8 +/- 0.7 days in the PCT group (P < 0.0001), while mean analgesic requirements were 9.7 +/- 3.2 doses in the LPT group and 2 +/- 0.9 doses in the PCT group (P < 0.0001). Mean number of intra-arterial hepatic chemotherapy cycles administered was 6.5 +/- 4.2 in the LPT group and 4.3 +/- 3.4 in the PCT group (P = 0.038). The overall incidence of device-related complications causing suppression of intra-arterial hepatic chemotherapy was 42.7% in the PCT group and 7.1% in the LPT group (P = 0.005).
Surgical implantation is still recommended when laparotomy has to be performed for other contextual procedures, such as colorectal or hepatic resection, while percutaneous transaxillary catheter placement is indicated for palliative or neoadjuvant intra-arterial hepatic chemotherapy.
背景/目的：基于氟尿苷输注的肝动脉内化疗是治疗结直肠癌肝转移的有效方法。本研究的目的是比较手术和经皮经腋窝途径将导管植入肝动脉以进行氟尿苷肝动脉内化疗的效果。
56例患者接受了肝动脉内化疗的动脉装置。28例患者（LPT组）接受开腹手术将导管植入肝动脉，另外28例患者（PCT组）通过经腋窝经皮穿刺途径将导管经皮植入肝动脉。从肝动脉内化疗周期数、导致肝动脉内化疗中断的与装置相关的并发症以及手术的生物学成本方面对手术和经皮经腋窝途径的安全性和有效性进行了比较分析。
LPT组术后平均住院时间为8.2±2.2天，PCT组为1.8±0.7天（P<0.0001），而LPT组平均镇痛需求量为9.7±3.2剂，PCT组为2±0.9剂（P<0.0001）。LPT组平均肝动脉内化疗周期数为6.5±4.2，PCT组为4.3±3.4（P=0.038）。导致肝动脉内化疗中断的与装置相关的并发症的总发生率在PCT组为42.7%，在LPT组为7.1%（P=0.005）。
当因其他相关手术（如结直肠癌或肝切除术）必须进行开腹手术时，仍建议采用手术植入方式，而经皮经腋窝导管置入适用于姑息性或新辅助性肝动脉内化疗。
