经股浅动脉入路药盒植入术并发症及处理

目的：介绍经股浅动脉入路药盒植入术并发症相应处理方法。材料与方法：６０便,男５３例,女７例,平均年龄４９岁。无栓塞适应症的原发性肝癌３６例,转移性肝癌１４例,其他晚期肿瘤１０便。经经股浅动脉植入药盒。结果：随时间最长１８月,药盒导管移位５例（８．３％）,靶血管闭塞２例（３．３％）,药盒导管闭塞３例（５．５％）。伤口延迟愈合１例（１．６％）。导管移位镁采用介入技术调整导管至腹主词汇经盒导管闭塞溶栓再     

经皮经股动脉植入药盒在晚期恶性肿瘤治疗中的应用

目的：探讨经股动脉植入药盒的操作技术，论证此种植入方法的可行性。材料与方法：５２例晚期恶性肿瘤患者采取经皮经股动脉植入药盒治疗，其中肝癌４４例，肺癌３例，盆腔肿瘤３例，肾癌和十二指肠壶腹部癌各１例，依据肿瘤供血特点，在ＤＳＡ路标及透视监控下，施行药盒植入术。药盒导管端植入靶动脉内，药盒体埋置在穿刺点下方皮下（大腿内侧），术后两周１次冲洗药盒。结果：随访３￣１８个月，并发症为：导管移位５例，靶动脉闭     

经导管血管内溶栓治疗急慢性动脉闭塞性疾患

目的：探讨经导管血管内溶栓治疗的疗效、价值和方法。方法：6例患者经健侧股动脉穿刺置管,其中1例腹主动脉肾动脉平面以广泛栓塞者,采用肱动脉置管。首先有确血栓部位与范围,用导丝或／与导管开辟血栓性“隧道”,充分抽吸血栓物与变性坏死血液后,采用微量泵注入国产尿激酶50万U加生理盐水50ml／3－4h。结果：腹主动脉广泛血栓1例,股浅动脉和Go动脉各2例,外伤性腋动脉1例,除后者外溶通率达100％,平均溶通时间21．4h。结论：经导管血管内溶栓治疗,疗效可靠,方便快捷,是治疗闭塞性血管疾患的首选方法。     

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。     

治疗节段性血管狭窄新方法:球囊内球囊血管成形术

作者提出了一种新的治疗方法,对血管之不同病变水平的不同直径的狭窄应用超薄型Meditech与Tegwire 型导管组合,分别做较大与较小血管的成形术。首先经无症状的腿穿刺行诊断性造影,血管成形术前,将导管沿主动脉分歧送入,置于拟治疗侧的髂外动脉内,然后作顺行穿刺进入股总动脉,把一支5F 诊断导管插入浅股动脉,沿着导管将导丝小心地穿过近端病变,将原导管调换为适当大小的超薄型球囊导管扩张病变。一旦获得满意结果,将球囊导管留在治疗的病变远端,然后沿该导管送入适当尺寸的Tegwire 球囊导管,轻轻地通过和扩张更远端的病变。经髂外动脉内的导管注射造影剂核实扩张结果,一旦成形术完成则将Tegwire退入超薄导管内,然后从双侧腹股沟拔管和加压     

国产植入式导管药盒系统经皮股动脉植入术治疗恶性肿瘤(附32例报告)

目的研究国产植入式导管药盒系统(PCS)经皮股动脉植入术在恶性肿瘤治疗中的应用。材料与方法全组32例患者,肝癌15例,肺癌6例,食管癌3例,转移性肝癌3例,胃癌2例及盆腔肿瘤3例。均采用国产 PCS,留置管经皮股动脉穿刺 Seldinger 技术留置在肿瘤主要供血动脉内或开口处;药盒则植入穿刺点下方大腿内侧皮下。术后设计合理方案经 PCS 对肿瘤进行区域性治疗。结果全组病例 PCS 植入成功率100%,留置管到位率为93.7%,并发症为12.5%。结论国产 PCS 经皮股动脉植入顺利,质量稳定可靠,价格低,可以替代同类进口产品;经皮股动脉植入PCS 治疗恶性肿瘤,操作简单,创伤小,疗效肯定,是恶性肿瘤区域性治疗的一种新途径。     

国产埋入式药盒介入法植入的临床应用

目的：研究国产埋入式药盒系统（PCS）介入法植入的可能性及安全性。材料和方法：对63例恶性肿瘤，采用国产PCS行经皮血管内植入术，术后经PCS化疗或栓塞。结果：PCS植入全部成功，留置管均位于肿瘤供养动态。并发症有穿刺局部血肿5例（7．9％），切口延迟愈合或开裂4例（6．3％），留置必这阻塞4例（6．3％），留置导管移位1例（1．55），局部感染2例（3．1％）。所有并发症经相应处理后痊愈，无严重后遗症。结论：国产PCS介入法植入是可行的，安全的。     

下肢深静脉血栓的经动脉溶栓治疗

目的：探讨经动脉保留导管溶栓治疗下肢深静脉血栓的应用价值。方法：40例下肢深静脉血栓患者经健侧股动脉穿刺插管至患侧髂股动脉内，并保留导管3－7d，经导管注入肝素3000－5000IU及尿激酶25万－100万IU稀释液50－200ml，每日1次。另40例经足背静脉注入同样的药物。共植入下腔静脉滤器31例，髂股静脉支架植入术10例。结果：80例患肢肿胀、疼痛均于溶栓治疗后1－3d内开始消退、减轻。31例滤器均未发生移位变形，下腔静脉通畅，10例支架无阻塞。结论：经动脉保留导管溶栓治疗下肢深静脉血栓形成，安全有效。     

血管内超声溶解外周动脉血栓的研究

目的 评价血管内超声溶栓治疗急性外周动脉血栓形成的疗效。材料与方法 ２４例患者经血管造影证实，股浅动脉血栓形成２１例，Ｇｕｏ动脉血栓形成２例，肱动脉血栓形成１例。对下肢动脉血栓采用对侧或同侧股动脉穿刺，插入超声导管溶栓；对上肢动脉血栓采用股动脉穿刺，插入超声导管至上肢动脉深栓。２４例患者均进行４～６分钟血管内超声溶栓治疗。结果 ２４例治疗后即刻造影显示血管内超声成功溶解了动脉内血栓，有１例治疗２４     

双向内膜下血管成形术在治疗下肢动脉闭塞症中的应用

目的 探讨双向内膜下血管成形术在治疗周围动脉完全闭塞性病变中的意义。方法 采用双向内膜下血管成形术治疗5例长段动脉闭塞患者,其中腹主动脉下端合并两侧髂总动脉及髂外动脉闭塞1例,髂外动脉闭塞2例,股浅动脉闭塞2例。在单向内膜下再通时,进入真腔失败后而在患肢闭塞动脉远端血管穿刺,使用导丝从病变对侧进入闭塞段内膜下,在病变内膜下腔,采用导丝贯穿至对侧导管技术,成功后,将导丝从对侧导管引出体外,然后用球囊扩张成型并植入支架。结果 本组5例患者均成功完成双向内膜下再通,共植入支架9枚。结论 双向内膜下再通可以作为单向内膜下再通进入真腔失败时的补救方法,可有效提高血管成形术的成功率。     

经股动脉右下腹导管药盒系统植入术

目的：研究动脉内导管药盒系统植入新方法。方法：４５例恶性肿瘤患者施行经股动脉导管药盒系统植入术,药盒植入右下腹壁下。结果：４５例均植入成功。结论：该术是一种安全、有效的植入方法。     

Percutaneous implantation of a Port-Catheter System using the left subclavian artery

Purpose: To evaluate the safety and feasibility of a percutaneous Port-Catheter System (PCS) implanted via the subclavian artery (SCA) for regional chemotherapy or chemoembolization of thoracic, abdominal, and pelvic malignant tumors. Methods: Percutaneous puncture of the SCA was performed in 256 patients with thoracic, abdominal, or pelvic malignant tumors; then a catheter was inserted into the target artery. After the first transcatheter chemotherapy or chemoembolization with an emulsion of lipiodol and anticancer agents, an indwelling catheter was introduced with its tip placed in the target artery and its end subcutaneously connected to a port. Results: The procedure was successfully completed in all 256 cases (100%). The indwelling catheter tip was satisfactorily placed in the target arteries in 242 cases (98%). Complications attributable to the procedure occurred in 20 (7.8%) cases, including pneumothorax (n = 10, 4%), hemothorax (n = 1, 0.4%), infections in the pocket (n = 4, 1.6%), and hematoma at the puncture site (n = 5, 2%). There were no severe sequelae or deaths. The duration of PCS usage was 1–36 months (median 9.5 months). During the course of treatment, occlusion of the target artery occurred in 20 cases (7.8%). Dislocation of the tip of the indwelling catheter occurred in 12 cases (4.7%); in 10 of the 12, the tip of the indwelling catheter was repositioned into the target artery. In all 10 cases no large symptomatic hematomas developed after the PCS was removed. Conclusion: Percutaneous PCS implantation via the left SCA, a relatively new procedure, is a safe and less invasive treatment approach than surgical placement for malignancies.     

90钇玻璃微球治疗肝癌的临床研究

探讨＾９０钇玻璃微球治疗肝癌的临床效果。材料与方法,１９９６年８月至１９９８年５月,应用＾９０钇治疗肝癌１７例,采用含有＾９０钇的三明治疗法：首先注入＾９０钇和超注化碘油悬浮液,然后注入三联合化疗药,最后用明胶海绵颗粒栓塞。对其中１２例施行了经皮股动脉药盒导管系统植入,并对操作技术进行了改进。     

经皮股动脉全植入式导管药盒系统

目的：探讨经皮股动脉全植入式导管药盒系统（ＰＣＳ）的临床应用。方法：对３０例腹、盆部晚期恶性肿瘤病人，采用介入技术植入ＰＣＳ，作局部动脉内长期灌注化疗。肝转移瘤１９例，直肠癌４例，卵巢癌７例。结果：植入ＰＣＳ３０副。导管留置肝动脉１９例，左髂内动脉６例，右髂内动脉５例。药盒埋植右下腹皮下２５例，左下腹皮下５例。植入成功率１００％。结论：应用介入技术植入ＰＣＳ，创伤小，成功率高，是长期局部动脉内灌注化疗的新方法。     

经皮不同径路肝动脉内植入药盒导管系统的对照研究

探讨肝动脉内植入药盒导管系统的最佳径路。材料与方法２１６例中晚期肝癌,１１８例采取经皮左锁骨下动脉径路肝动脉内植入ＰＣＳ,另外９８例采取经皮股动脉径路植入ＰＣＳ。结果ＬＳＡ组与ＦＡ组植入成功率分别为９１．５％和８８．７％。结论常规采取ＦＡ径路肝动脉内植入ＰＣＳ安全可行。     

Management of end hole in placement of port-catheter system for continuous hepatic arterial infusion chemotherapy using the fixed catheter tip method

OBJECTIVE: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.     

Withdrawal of port-catheter system for hepatic arterial infusion chemotherapy implanted with fixed catheter tip method

PURPOSE: To evaluate the feasibility and safety of a method to withdraw port-catheter systems implanted by the fixed catheter tip method. MATERIALS AND METHODS: Retrospective review was conducted of 14 cases of unresectable advanced liver cancer in which it was necessary to attempt 15 withdrawals of percutaneously placed implantable port-catheter systems. Reasons for withdrawal, withdrawal success, complications, and subsequent treatment of patient were evaluated. RESULTS: In 14 of the 15 procedures (93.3%), the port-catheter system was successfully retrieved. Because continuation of hepatic arterial infusion chemotherapy was necessary in 10 procedures, a second implantation was performed after withdrawal of the initial catheter. Only one complication occurred, in which the indwelling catheter was broken in the aorta during withdrawal. CONCLUSION: When retrieval of a port-catheter system implanted with the fixed catheter tip method is necessary, withdrawal can be accomplished safely with high frequency.