Campbell K A, Burns R C, Sitzmann J V, Lipsett P A, Grochow L B, Niederhuber J E
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD.
J Clin Oncol. 1993 May;11(5):822-6. doi: 10.1200/JCO.1993.11.5.822.
Regional hepatic arterial infusion (HAI) devices have been used for 17 years, but reports of unacceptably high complication rates have led to controversy about their use. Inadequate or misdirected infusion has been reported to occur in up to 45% of patients. We evaluated whether surgeon experience or presence of variant arterial anatomy related to risk of coagulation.
We reviewed 70 patients undergoing placement of HAI catheters. Surgeons were classed as experienced after 10 procedures and arterial anatomy was evaluated angiographically with confirmation at operation. Complications were categorized as technical (17%) or chemotherapy-related (16%).
Inexperienced surgeons had a technical complication rate of 37% (80% of the patients involved had standard anatomy), while experienced surgeons had a technical complication rate of 7% (P < .01). Experienced surgeons had no complications in patients with standard anatomy, while inexperienced surgeons had a 42% (eight of 19) complication rate in similar patients (P < .01).
We conclude that technical complications are closely associated with surgeon experience and arterial anatomy.
区域性肝动脉灌注（HAI）装置已使用17年，但关于其并发症发生率过高而难以接受的报道引发了对其使用的争议。据报道，高达45%的患者存在灌注不足或灌注方向错误的情况。我们评估了外科医生的经验或变异动脉解剖结构的存在是否与凝血风险相关。
我们回顾了70例行HAI导管置入术的患者。在完成10例手术后，外科医生被归类为经验丰富，并且通过血管造影评估动脉解剖结构，并在手术中进行确认。并发症分为技术相关（17%）或化疗相关（16%）。
经验不足的外科医生技术并发症发生率为37%（80%的相关患者具有标准解剖结构），而经验丰富的外科医生技术并发症发生率为7%（P < 0.01）。经验丰富的外科医生在具有标准解剖结构的患者中无并发症发生，而经验不足的外科医生在类似患者中的并发症发生率为42%（19例中的8例）（P < 0.01）。
我们得出结论，技术并发症与外科医生的经验和动脉解剖结构密切相关。
