Schelhorn Juliane, Ertle Judith, Schlaak Joerg F, Mueller Stefan, Bockisch Andreas, Schlosser Thomas, Lauenstein Thomas
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Department of Gastroenterology und Hepatology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Springerplus. 2014 Oct 10;3:595. doi: 10.1186/2193-1801-3-595. eCollection 2014.
Selective internal radiation therapy (SIRT) using 90-yttrium is a local therapy for unresectable liver malignancies. Non-targeted 90-yttrium diversion via a patent hepatic falciform artery (HFA) is seen as risk for periprocedural complications. Therefore, this study aimed to evaluate the impact of a patent HFA on SIRT. 606 patients with SIRT between 2006 and 2012 were evaluated retrospectively. SIRT preparation was performed by digital subtraction angiography including (99m)Tc-HSAM administration and subsequent SPECT/CT. Patients with an angiographically patent HFA were analyzed for procedural consequences and complications. 19 of 606 patients (3%) with an angiographically patent HFA were identified. Only 11 of these 19 patients received 90-yttrium in the hepatic vessel bed containing the HFA. Initial coil embolization of the HFA succeeded only in three of 11 patients. Out of the eight remaining patients four had no abdominal wall (99m)Tc-HSAM accumulation. The other four patients presented with an abdominal wall (99m)Tc-HSAM accumulation, for those a reattempt of HFA embolization was performed or ice packs were administered on the abdominal wall during SIRT. In summary, all patients tolerated SIRT well. A patent HFA should not be considered a SIRT contraindication. In patients with abdominal wall (99m)Tc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.
使用90钇的选择性内放射治疗（SIRT）是一种针对不可切除肝脏恶性肿瘤的局部治疗方法。经肝镰状韧带动脉（HFA）出现的非靶向性90钇分流被视为围手术期并发症的风险因素。因此，本研究旨在评估HFA通畅对SIRT的影响。对2006年至2012年间接受SIRT治疗的606例患者进行了回顾性评估。通过数字减影血管造影进行SIRT准备，包括注射（99m）Tc-HSAM并随后进行SPECT/CT检查。对血管造影显示HFA通畅的患者分析其手术后果和并发症。在606例患者中，有19例（3%）血管造影显示HFA通畅。在这19例患者中，只有11例在含有HFA的肝血管床接受了90钇治疗。HFA的初始线圈栓塞仅在11例患者中的3例成功。在其余8例患者中，4例腹壁无（99m）Tc-HSAM积聚。另外4例患者腹壁有（99m）Tc-HSAM积聚，对于这些患者，在SIRT期间对HFA栓塞进行了再次尝试或在腹壁上使用了冰袋。总之，所有患者对SIRT耐受性良好。HFA通畅不应被视为SIRT的禁忌症。对于腹壁有（99m）Tc-HSAM积聚的患者，HFA栓塞或使用冰袋似乎可预防并发症。
