经皮左锁骨下动脉穿刺植入药盒治疗晚期恶性肿瘤

目的 评价经皮左锁骨下动脉植入药盒在晚期恶性肿瘤治疗中的应用价值。方法 对200例中晚期恶性肿瘤病人采用经皮左锁骨下动脉植入药盒治疗。其中原发性肝癌178例,转移性肝癌10例,盆腔肿瘤5例,胆囊癌4例,肺部3例。依据肿瘤供血情况,在DSA路标及透视监控下,施行药盒植入术,药盒体埋置在穿刺点下方的左前胸壁皮下,药盒导管端植入靶动脉内。术后经药盒行规则性化疗或磺油化疗乳剂栓塞。结果 随访3个月－3年,200例病人共植入202个药盒,其中2例肝癌病人因左、右肝动脉各自供血肿瘤,故在右股动脉加埋一个药盒（双药盒）。植入成功率为99％。并发症有9例（4．5％）：导管移位2例（1％）、导管－药盒松脱1例（0．5％）、气胸2例（1％）、皮肤溃烂1例（0．5％）、皮下大量渗血1例（0．5％）,靶血管闭塞2例（1％）。无严重并发症。结论 经皮左锁骨下动脉行药盒植入术安全可行、操作简便易行、创伤小,为动脉内化疗灌注和碘油化疗乳剂栓塞提供了一条安全可靠的途径。

Percutaneous port-catheter system implantation via left subclavian artery in the treatment of advanced malignant neoplasms

Objective To evaluate the value of percutaneous port catheter system(PCS) implantation via left subclavian artery in the treatment of advanced malignant neoplasms. Methods The technique was used to treat 200 patients with advanced malignant neoplasms, 178 cases of primary liver carcinoma, 10 cases of metastastic liver cancer, 5 cases of pelvic noeplasm, 4 cases of gallbladdler carcinoma, 3 cases of lung cancer. We performed implantation of PCS under guidance of DSA and fluoroscopy according to the arterial blood supply of tumors. Body of PCS was subcutaneously implanted below puncture point. The implanted catheter tip was positioned in the target artery. Intra arterial chemotherapy or chemoemblization with emulision of anticancerous agents and lipiodol were regularly carried out via PCS. Results 200 patiens were traced for 3 months to 3 years, 202 PCS were implanted in 200 patients. Because of left and right hepatic artery suppied tumor simultanetusly in 2 patients with liver cancer, another PCS was implanted for the right femoral artery(double PCS). The successful rate was 99%. Complications occurred in 7 cases(3.5%), including indwelling catheter tip dislocation(2 cases,1%), disconnection between port and catheter after the procedure(1 cases, 0.5% ), pneumothorax(2 cases,1%), skin fester(1 cases,0.5%), massive blood effusion in subcutaneous tissue(1 cases,0.5%), target vessel closed off (2 cases,1%). There was no serious complication. Conclusion Percutaneous PCS implantation via left subclavian artery is safe, feasible and less traumatic. It provides a safe intra arterial chemotherapy or chemoembolization with emulision of anticancerous agents and lipiodol for patient with malignant tumor.