经皮锁骨下动脉穿刺导管药盒植入系统的临床护理

经导管动脉内化疗灌注术在恶性实体瘤的治疗中占有重要地位。传统方法有经股动脉穿刺插管至靶动脉行一次性冲击化疗灌注。此途径难以进行长期间断性化疗,而长期灌注化疗需外科手术留置导管,但仍存在创伤大,置管位置欠精确缺点。为了克服上述方法的不足之处,我院采用经皮左锁骨下动脉穿刺配合皮肤小切口植入导管药盒系统(简称PCS),治疗病人36例均获得成功,并取得较好疗效。在治疗过程中均需护理人员密切配合,现将护理体会报告如下。     

经皮锁骨下动脉穿刺导管药盒植入系统的临床护理

经导管动脉内化疗灌注术在恶性实体瘤的治疗中占有重要地位。传统方法有经股动脉穿刺插管至靶动脉行一次性冲击化疗灌注。此途径难以进行长期间断性化疗，而长期灌注化疗需外科手术留置导管，但仍存在创伤大，置管位置欠精确缺点。为了克服上述方法的不足之处，我院采用经皮左锁骨下动脉穿刺配合皮肤小切口植入导管药盒系统(简称PCS)，治疗病人36例均获得成功，并取得较好疗效。在治疗过程中均需护理人员密切配合，现将护理体会报告如下。     

锁骨下动脉经皮导管药盒系统植入法的临床应用

目的:探讨锁骨下动脉经皮完全植入式导管药盒系统(PCS)优缺点及临床应用价值。材料和方法:20列恶性肿瘤患者,经皮锁骨下动脉 PCS 植入术,术后经 PCS 化疗和栓塞。结果:PCS 植入全部成功,并发症发生率14.3%。结论:PCS 介入法是一种安全有效的治疗肿瘤的方法。     

经股动脉微型导管药盒系统植入治疗膀胱癌的疗效观察

目的 评价经股动脉微型导管药盒系统(miniature port-catheter system,MPCS)植入治疗膀胱癌的疗效.方法 16例膀胱癌患者先行双侧髂内动脉前干化疗栓塞,明胶海绵颗粒加弹簧圈栓塞非主要供血侧髂内动脉前干,主要供血侧髂内动脉前干用明胶海绵颗粒做适量栓塞后,经股动脉植入MPCS,导管留置于主要供血侧髂内动脉前干,术后定期经MPCS灌注化疗,化疗方案为吡柔比星、卡铂和丝裂霉素.结果 16例患者均成功植入MPCS,经过52例次穿刺药盒灌注化疗后,肿瘤完全缓解(CR)3例,部分缓解(PR)11例,稳定(SD)1例,总有效率(CR+PR)为87.5%(14/16),其中3例PR患者结合适形放疗后2例肿瘤消失,1例患者肿瘤明显缩小,经尿道膀胱肿瘤切除后继续经MPCS灌注化疗,未见肿瘤复发.全部患者经1个疗程的化疗后血尿消失,临床症状得到缓解,生活质量明显提高.经留置MPCS灌注化疗的毒副反应轻微,无严重并发症发生.结论 经股动脉微型导管药盒系统植入治疗膀胱癌的疗效满意,技术简便、安全,值得推广应用.     

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。     

经皮左锁骨下动脉导管药盒系统置入术的中远期并发症及处理

目的　探讨经皮左锁骨下动脉导管药盒系统 (PCS)置入术的中远期并发症的原因及处理方法。材料与方法　 2 5 6例胸、腹部和盆腔等部位的晚期恶性肿瘤患者 ,行经皮左锁骨下动脉穿刺PCS置入术。术后隔 3 0～ 40天行经PCS灌注化疗或碘油化疗乳剂栓塞术。随访 2个月～ 3年 ,平均 11.5个月。结果　使用时间为 1～ 3 6个月 ,平均为 10 .5个月。PCS置入术 3 0天后 ,5 3例发生与PCS有关的并发症 ,发生率为 2 0 .7%。主要包括 :除主动脉置管者外 ,留置管移位率为 7.8% ( 16/2 0 5 ) ,靶动脉闭塞占 7.4%( 19/2 5 6)。二者经原途径更换新的留置导管和调整到满意位置 16例 ,拔除PCS 8例 ,其余 11例未作处理。留置导管阻塞占 2 .0 %( 5 /2 5 6) ,经加压注入尿激酶溶液PCS再通 2例。药盒囊腔内积血占 2 .0 % ( 5 /2 5 6) ,经局部穿刺抽吸或切开引流治疗后痊愈。皮肤坏死占 3 .1% ( 8/2 5 6) ,均拔除PCS。结论　经皮左锁骨下动脉PCS置入术的中远期并发症 ,发生率较低 ,大多数经适当处理 ,不影响PCS的正常使用。     

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。     

肝癌经肝动脉化疗栓塞及门静脉持续灌注化疗的临床研究

目的　将经肝动脉化疗栓塞 (TACE)和经门静脉植入化疗药盒持续灌注化疗药 (VPC) 2种方法结合 ,观察原发性肝癌(HCC)经肝动脉化疗栓塞和经门静脉植入化疗药盒持续灌注化疗药的疗效。方法　对照组 83例中晚期患者 ,用表柔比星 (EPI) 40mg和顺铂 (CDDP) 80mg与碘化油配制成碘油———化疗药物乳化剂 ,经导管向肝癌供血动脉注入 ,后用明胶海绵 (GS)颗粒栓塞该动脉。治疗组 5 9例中晚期HCC患者 ,用上述方法治疗后 ,再经皮下埋置式药盒经门静脉定期灌注化疗药。结果　对照组与治疗组有效率 (完全缓解 部分缓解 )分别为 45 .8%和 61.0 % (P <0 .0 5 ) ,2组治疗后Ⅱ期手术切除率分别为 3 .6%和 11.9% (P <0 .0 5 )。对照组 1年、2年、3年生存率分别为 69.9%、60 .2 %和 2 0 .5 % ;治疗组分别为 96.6%、67.8%和 42 .4% (P <0 .0 5 )。并发症差异无显著性意义。结论　经肝动脉化疗栓塞和经门静脉植入化疗药盒持续灌注化疗药是治疗原发性肝癌的较好方法 ,能提高疗效     

经皮股动脉导管药盒系统植入术的并发症及临床处理

目的探讨经股动脉导管药盒系统植入术(PCS)的并发症原因及处理。方法202例胸、腹、盆腔及四肢恶性肿瘤采用经皮股动脉植入PCS进行化疗和碘油栓塞。分析其相关并发症35例(17．3％)。结果并发症包括6例切口感染及切口延迟愈合(17．1％)，2例穿刺局部延迟出血(5．7％)，3例PCS留置管坠落(8．6％)，1例连接不牢分离(2．9％)，1例渗漏(2．9％)，1例药盒转面(2．9％)，11例PCS堵塞(31．4％，和10例留置导管尖移位(28．6％)。所有并发症经适当处理后无一例死亡和严重后遗症。结论经皮股动脉药盒系统植入术是一种安全有效技术，其相关并发症轻微和易于处理。     

经皮锁骨下动脉导管药盒系统植入术的护理

经皮锁骨下动脉 (ＳＣＡ)导管药盒系统 (ＰＣＳ)植入术是在Ｘ线监视下经皮穿刺锁骨下动脉成功后 ,将导管植入靶动脉 ,并与锁骨下区皮下药盒连接[1,2 ] 。较手术动脉内植入ＰＣＳ具有操作简单、创伤小、并发症少、置管位置准确等优点。为长期规律性动脉内化疗灌注及碘油化疗乳剂栓塞治疗恶性肿瘤建立了良好途径。较一次性动脉插管灌注有治疗规律 ,注药时间可控 ,不用重复插管等优点。现将该术的护理作一介绍。一、临床资料胸、腹部及盆腔恶性肿瘤无手术切除指征患者2 35例 ,其中肝癌 130例 ,肝转移瘤 58例 ,肺癌 18例 ,食管癌 10例 ,直肠癌术…     

Brain infarction after percutaneous implantation of port-catheter system via the left subclavian artery

The aim of this study was to evaluate the incidence of brain infarction after percutaneous implantation of a port-catheter system via the left subclavian artery for hepatic arterial infusion chemotherapy. In 90 patients with inoperable liver cancer, a port-catheter system was implanted via the left subclavian artery. In 5 patients (5.6%) brain infarction occurred after port-catheter implantation. In one patient (1.1%) thrombi formed around the catheter, as confirmed by autopsy. The risk of brain infarction should be taken into consideration when a trans-left subclavian arterial access route is used for the percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy.     

Percutaneous transluminal angioplasty for hepatic arterial occlusion following hepatic arterial infusion chemotherapy

We report a case in which hepatic arterial occlusion developed during repeated hepatic arterial infusion chemotherapy through an implanted port-catheter system for advanced malignant hepatic neoplasia. After successful recanalization of the hepatic artery by using percutaneous transluminal angioplasty, another port-catheter system was placed percutaneously by interventional radiology techniques, allowing the continuation of hepatic arterial infusion chemotherapy.     

Embolization of accessory left gastric artery to prevent acute gastric mucosal lesions in patients undergoing repeated hepatic arterial infusion chemotherapy

Purpose: To retrospectively evaluate results of selective embolization of the accessory left gastric artery prior to repeated hepatic arterial infusion chemotherapy using a port-catheter system.

Material and Methods: Of 22 patients with unresectable advanced liver cancer who underwent percutaneous implantation of a port-catheter system, an accessory left gastric artery was revealed by arteriography in 16 patients before and in six patients after port-catheter implantation. The right gastric artery was embolized to prevent gastric mucosal lesions in all 22 patients. In addition, the accessory left gastric artery was selectively embolized for the same purpose using from one to six microcoils, which were from 3 to 5 mm in diameter. Within 10 days after implantation, arteriography was performed while contrast material was infused via the port.

Results: Selective embolization of the accessory left gastric artery was successful in all 22 patients. No complication related to embolization of this artery occurred in any patient. A gastrointestinal mucosal lesion developed in only one case during hepatic arterial infusion chemotherapy, but was unrelated to the accessory left gastric artery.

Conclusion: Prophylactic embolization of the accessory left gastric artery is useful to avoid development of a gastrointestinal mucosal lesion resulting from hepatic arterial infusion chemotherapy.     

Arterial port catheter system placement using a translumbar aortic route.

RATIONALE AND OBJECTIVES: Implantable ports for arterial infusion hold promise in a growing number of clinical applications, including regional chemotherapy and gene therapy. Percutaneous placement of arterial infusion ports has been described clinically; however, existing sites of access pose unique anatomic challenges. The feasibility of translumbar aortic placement of a port-catheter system for long-term arterial infusion was assessed. MATERIALS AND METHODS: Eight swine underwent placement of a percutaneously implantable arterial port-catheter system using a translumbar aortic approach for catheter placement. The tip of the catheter was positioned in the left or right hepatic artery and the port reservoir implanted in the paraspinal subcutaneous tissues. Patency and position of the port-catheter system were assessed at 7 to 10 days and 28 days. The insertion procedure was modified in two animals by introducing tissue adhesive around the catheter to prevent dislodgment. RESULTS: Immediate technical success was achieved in 6 of 8 animals (75%). Catheters were dislodged into the aorta in two animals on the day of the procedure, extravascular in four animals and intra-aortic in one animal by day 10. One animal died at 21 days of sepsis. The port-catheter systems remained functional at 28 days with catheters positioned within the left or right hepatic artery in three animals, including two animals in which the catheter had been fixated within the paraspinal soft tissues with tissue adhesive. CONCLUSIONS: A translumbar aortic route for percutaneous placement of arterial infusion port-catheter systems is feasible in swine and holds potential as an ancillary access site in a clinical setting if the obstacle of catheter fixation can be overcome.     

Implantation of a port-catheter system through the superior mesenteric artery for repeated hepatic arterial infusion chemotherapy

Between March 1999 and March 2006, 292 patients at the authors' institution required placement of a percutaneously implantable port-catheter system through which repeated hepatic arterial infusion chemotherapy would be administered. In 10 patients, the port-catheter system was implanted through the superior mesenteric artery. In these patients, implantation through the superior mesenteric artery instead of the celiac artery was necessary because all hepatic arteries arose from the superior mesenteric artery or because the blood supply to almost all tumors was from a hepatic artery arising from the superior mesenteric artery. Implantation of the port-catheter system was successful without complications in these 10 patients.     

Interventional radiologic treatment for hepatic arterial occlusion after repeated hepatic arterial infusion chemotherapy via implanted port-catheter system

The present study evaluated the feasibility of interventional radiologic treatments for hepatic arterial occlusion after hepatic arterial infusion chemotherapy (HAIC) via an implanted port-catheter system. Treatment for hepatic arterial occlusion was attempted in seven patients with unresectable liver cancer. In six, the obstructed hepatic artery was recanalized. In three patients, the recanalized hepatic artery again became obstructed. However, by performing additional interventional radiologic procedures, secondary patency of the hepatic artery was successfully obtained in two patients. In conclusion, when hepatic arterial occlusion occurs, HAIC can be resumed in the attempt to recanalize the hepatic artery.     

Using n-butyl cyanoacrylate and the fixed-catheter-tip technique in percutaneous implantation of a port-catheter system in patients undergoing repeated hepatic arterial chemotherapy

OBJECTIVE: The purpose of our study was to evaluate the usefulness of adding n-butyl cyanoacrylate to microcoils to fix the catheter tip in percutaneous implantation of a port-catheter system for hepatic arterial-infusion chemotherapy. SUBJECTS AND METHODS: Ninety-three patients (64 men and 29 women; age range, 38-83 years; mean age, 62.2 years) with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system with the catheter tip fixed at the gastroduodenal artery with microcoils and a mixture of n-butyl cyanoacrylate and iodized oil. The rates of successful implantation and complications closely associated with this technique and management of the complications were reviewed. RESULTS: Percutaneous port-catheter placement was successfully performed in all patients. However, in eight patients, complications occurred: hepatic arterial obstruction (n = 5, 5.4%); catheter dislocation (n = 2, 2.2%); recanalization of the gastroduodenal artery (n = 1, 1.1%); or movement of n-butyl cyanoacrylate (n = 1, 1.1%). In five of the eight patients with complications, hepatic arterial-infusion chemotherapy was continued either after observation of the patient to ensure that stability had been established or after treatment using comparatively easy interventional techniques. In three (3.2%) of the 93 patients, planned hepatic arterial-infusion chemotherapy could not be performed because of complications associated with the technique. CONCLUSION: Fixation of the catheter tip in the gastroduodenal artery using a combination of microcoils and a mixture of n-butyl cyanoacrylate and iodized oil is a useful and safe technique in percutaneous port-catheter placement for repeated hepatic arterial infusion chemotherapy.     

Movement of the side hole occurring in a port-catheter system percutaneously implanted for hepatic arterial infusion chemotherapy

The authors report a case in which catheter-related difficulties occurred with a port-catheter system implanted to perform repeated hepatic arterial infusion chemotherapy for advanced hepatocellular carcinomas. The port-catheter system had been percutaneously implanted with the catheter tip fixation method, and a side hole had been created in the indwelling catheter for placement in the common hepatic artery. Four months after port-catheter placement, however, the indwelling catheter became bent at the location of the side hole in the proper hepatic artery. Subsequently, the side hole moved into the left hepatic artery, resulting in a lack of distribution of chemotherapeutic agents to the tumours in the segments of the liver supplied by the right hepatic artery. This situation was easily corrected with a simple interventional radiological method so that hepatic arterial infusion chemotherapy could be resumed with sufficient distribution over the entire liver. To our knowledge, such a problem involving a port-catheter system implanted with the catheter tip fixation method and its management thereafter has not been reported in the published literature.     

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

The purpose of the present study is to evaluate the feasibility of a method developed to withdraw a port-catheter system that had been implanted with use of the fixed catheter tip technique. Withdrawal of an implanted catheter was required in four patients with advanced liver cancer in whom port-catheter systems had been implanted for performance of repeated hepatic arterial infusion. In all patients, port-catheter systems were successfully removed without complications. In conclusion, an implanted port-catheter system can be removed even when implanted with the fixed catheter tip technique.     

A simplified method for continuous hepatic arterial port-catheter system placement not requiring catheter end-hole occlusion

Purpose: To evaluate the efficacy of hepatic port-catheter system placement without distal catheter tip occlusion or gastroduodenal artery embolization distal to the catheter tip.

Material and Methods: A port-catheter system was percutaneously implanted in 29 patients (16 men, 13 women; mean age 65.6 years) with unresectable liver cancer. Persistent blood flow through the end hole of the catheter was verified immediately and 1-10 days after catheter placement.

Results: In all cases, percutaneous port-catheter placement was successfully performed. In seven of 29 (24.1%) patients, flow through the end hole of the catheter was verified immediately after the procedure. However, no flow was seen 1-10 days after the procedure.

Conclusion: It is not necessary to occlude the end hole of the catheter tip and embolize the gastroduodenal artery beyond the catheter tip when placing a port-catheter system for repeated hepatic arterial infusion chemotherapy.