Yamagami Takuji, Kato Takeharu, Iida Shigeharu, Hirota Tatsuya, Nishimura Tsunehiko
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan.
AJR Am J Roentgenol. 2005 Apr;184(4):1332-9. doi: 10.2214/ajr.184.4.01841332.
The purpose of our study was to compare persistent hepatofugal blood flow in the gastroduodenal artery after implanting a port-catheter system for repeated hepatic arterial infusion chemotherapy using either the original or the modified fixed catheter tip method. With the original method the lumen of the catheter tip is closed with a microcoil; with the modified method it is left open. Persistent hepatofugal blood flow can induce reactive gastric or duodenal mucosal lesions.
A port-catheter system with the catheter tip fixed to the gastroduodenal artery by embolic agents was percutaneously implanted in 156 patients (102 men, 54 women; mean age, 63.2 years) with unresectable liver cancer. In 98 patients the original method was used, and in 58 patients the modified method was used. Existence of persistent blood flow beyond the indwelling catheter tip as shown on arteriography via the port performed immediately and 2-10 days after port-catheter placement was compared between these two groups.
In all cases, percutaneous port-catheter placement was successfully performed. In one (1.0%) of 98 procedures involving the original method, the gastroduodenal artery was detected on arteriography just after implantation, compared with 23 (39.7%) of 58 procedures using the modified method. However, arteriography performed 2-10 days (mean, 5.02 days) after implantation detected the gastroduodenal artery in only one case.
This retrospective study indicates that closure of the end hole appears to occur spontaneously shortly after implantation. Thus, such closure is not always necessary to avoid persistent hepatofugal blood flow in the gastroduodenal artery.
我们研究的目的是比较在植入经皮肝动脉导管药盒系统用于重复肝动脉灌注化疗时，采用原始或改良的固定导管尖端方法后，胃十二指肠动脉中持续存在的肝外血流情况。原始方法是用微线圈封闭导管尖端的管腔；改良方法是使其保持开放。持续的肝外血流可诱发胃或十二指肠黏膜病变。
将通过栓塞剂将导管尖端固定于胃十二指肠动脉的经皮肝动脉导管药盒系统，经皮植入156例（男102例，女54例；平均年龄63.2岁）无法切除的肝癌患者体内。98例患者采用原始方法，58例患者采用改良方法。比较这两组在经皮肝动脉导管药盒系统置入后即刻及2 - 10天通过药盒进行血管造影时，留置导管尖端以外持续血流的存在情况。
所有病例经皮肝动脉导管药盒系统置入均成功。在采用原始方法的98例操作中，有1例（1.0%）在植入后即刻血管造影时检测到胃十二指肠动脉，而采用改良方法的58例操作中有23例（39.7%）。然而，在植入后2 - 10天（平均5.02天）进行的血管造影仅在1例中检测到胃十二指肠动脉。
这项回顾性研究表明，植入后不久端孔似乎会自发闭合。因此，为避免胃十二指肠动脉中持续的肝外血流，并不总是需要进行这种封闭。
