Yamagami Takuji, Kato Takeharu, Iida Shigeharu, Tanaka Osamu, Nishimura Tsunehiko
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-chyo, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan.
Radiology. 2004 Mar;230(3):792-802. doi: 10.1148/radiol.2303021564. Epub 2004 Jan 22.
To assess the value of transcatheter arterial embolization (TAE) of splanchnic arterial branches to allow continuous application of repeat hepatic arterial infusion chemotherapy (HAIC).
In 128 patients with unresectable advanced liver cancer, percutaneous implantation of a port catheter system and TAE of splanchnic arteries with coils and/or n-butyl cyanoacrylate (NBCA) were performed. Parameters included (a) methods selected for catheter placement; (b) embolic materials used (coils and/or NBCA, number of coils, administration rate of NBCA-iodized oil) for TAE of splanchnic arteries, details of embolized arteries, and frequency of recanalization; (c) ability to prevent gastrointestinal symptoms by avoiding inflow of anticancer drugs into extrahepatic adjacent organs and to maintain distribution of contrast agents in liver, as well as management of difficulties encountered; (d) complications related to catheter system implantation or to long-term HAIC and management of such complications; and (e) final success in performing scheduled HAIC while maintaining distribution over liver via a single route without gastrointestinal symptoms caused by inflow of anticancer drugs. Fisher exact test was used to compare recanalization rate between coil-embolized and NBCA- or NBCA-coil-embolized arteries, and frequency of heterogeneously poor distribution was compared between patients with single and those with multiple hepatic arteries.
Embolization was successful during first catheterization in 326 arteries and during follow-up in 10. In 119 (93.0%) of 128 patients, repeat HAIC was effective until death or the time of this writing (observation period, 2-47 months). HAIC was continued in two patients, although anticancer drugs did not distribute to all liver tumors. Arteries once embolized with coils alone spontaneously recanalized at a significantly higher rate than those with NBCA (eight of 192 vs one of 144, P =.048). Rate of heterogeneously poor distribution was significantly higher in those with two or more hepatic arteries than in those with one (seven of 17 vs nine of 111, P =.001).
TAE for various splanchnic organs is useful for efficient performance of long-term HAIC.
评估经导管动脉栓塞术（TAE）对内脏动脉分支进行栓塞，以允许持续重复进行肝动脉灌注化疗（HAIC）的价值。
对128例无法切除的晚期肝癌患者，行经皮植入门静脉导管系统，并采用弹簧圈和/或氰基丙烯酸正丁酯（NBCA）对内脏动脉进行TAE。参数包括：（a）导管置入所选方法；（b）内脏动脉TAE所用栓塞材料（弹簧圈和/或NBCA、弹簧圈数量、NBCA-碘化油给药速率）、栓塞动脉细节及再通频率；（c）通过避免抗癌药物流入肝外相邻器官预防胃肠道症状及维持对比剂在肝脏内分布的能力，以及所遇到困难的处理；（d）与导管系统植入或长期HAIC相关的并发症及其处理；（e）在通过单一途径维持肝脏内分布且无抗癌药物流入引起的胃肠道症状的情况下，成功完成预定HAIC的情况。采用Fisher精确检验比较弹簧圈栓塞动脉与NBCA或NBCA-弹簧圈栓塞动脉的再通率，比较单肝动脉患者与多肝动脉患者不均匀分布不良的频率。
首次导管插入时326条动脉栓塞成功，随访期间10条动脉栓塞成功。128例患者中有119例（93.0%）重复HAIC有效直至死亡或撰写本文时（观察期2 - 47个月）。2例患者继续进行HAIC，尽管抗癌药物未分布至所有肝肿瘤。单纯用弹簧圈栓塞过的动脉自发再通率显著高于用NBCA栓塞的动脉（192条中的8条 vs 144条中的1条，P = 0.048）。有两条或更多肝动脉的患者不均匀分布不良率显著高于只有一条肝动脉的患者（17例中的7例 vs 111例中的9例，P = 0.001）。
对各种内脏器官进行TAE有助于高效实施长期HAIC。
