Kuhner M, Tan B, Fiedler M O, Biecker O, Klein B, Chang D H, Weigand M A, Dietrich M
Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
Abteilung für Kardiotechnik, Klinik für Herzchirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
Anaesthesiologie. 2022 Nov;71(11):852-857. doi: 10.1007/s00101-022-01175-y. Epub 2022 Jul 18.
Percutaneous hepatic chemosaturation is a treatment option for unresectable primary or secondary liver tumors. In this procedure the part of the inferior vena cava (VCI) that collects blood from the hepatic veins is isolated using a double balloon catheter. Like this, systemic distribution of the chemotherapeutic agent melphalan which is administered via the hepatic artery can be prevented. After passage through the liver and drainage from the retrohepatic VCI, the chemosaturated blood passes through two extracorporeal filters. Subsequently, the filtered blood is returned via the jugular vein. The procedure is often accompanied by severe hemodynamic instability, the cause of which is still not completely understood. In addition, coagulation management of extracorporeal circulation is often challenging. The authors report a case in which a thrombus formed in the returning leg of the extracorporeal circulation despite sufficient activated clotting time (ACT). Targeted problem search and resolution were necessary simultaneously to hemodynamic stabilization and interdisciplinary collaboration to successfully perform the intervention and provide the patient with safe treatment.
经皮肝化学饱和是不可切除的原发性或继发性肝肿瘤的一种治疗选择。在该手术中，使用双球囊导管隔离收集肝静脉血液的下腔静脉（VCI）部分。这样，可防止通过肝动脉给药的化疗药物美法仑的全身分布。经肝并从肝后VCI引流后，化学饱和的血液通过两个体外过滤器。随后，过滤后的血液通过颈静脉回流。该手术常伴有严重的血流动力学不稳定，其原因仍未完全明确。此外，体外循环的凝血管理通常具有挑战性。作者报告了一例尽管活化凝血时间（ACT）足够，但体外循环回流支路仍形成血栓的病例。在进行血流动力学稳定和跨学科协作的同时，有必要进行针对性的问题查找和解决，以成功实施干预并为患者提供安全的治疗。
