经皮穿刺左肱动脉入路介入治疗原发性肝癌:兼与股动脉入路比较

目的　总结经皮穿刺左肱动脉入路介入治疗肝癌的初步经验 ,与股动脉入路比较该技术的优缺点。方法　 45 2例患者分为肱动脉组 5 2例和股动脉组 40 0例 ,2组患者均行超选择性肿瘤化疗栓塞。通过比较 2组操作的技术成功率、穿刺口血肿发生率、微导管可控性、患者的舒适程度 ,评价 2种方法的优缺点。结果　股动脉组失败 4例 ,技术成功率 99.0 % ,改用肱动脉入路和锁股下入路成功 ;肱动脉组全部成功 ,技术成功率 10 0 % ,Ρ >0 .0 5 ,无差别。股动脉组 4例 (1% )术后穿刺口形成血肿 ,肱动脉组有 9例 (17.3 % ) ,Ρ <0 .0 5 ,有差别。血肿未予特殊处理均自行吸收。股动脉组 75例使用微导管 ,5例操作困难 ,占 6.7% ;肱动脉组 3 6例使用微导管 ,2例不顺利 ,占 5 .6% ,Ρ >0 .0 5 ,无差别。股动脉组术后卧床 6h以上 ,均诉腰背酸痛 ,2 3例需插导尿管 ;肱动脉组术后不需卧床 ,无腰背痛。结论　经左肱动脉入路介入治疗肝癌 ,提高了患者的舒适和便利 ,是股动脉入路的补充。

The Transcatheter Arterial Chemoembolization of Hepatocellular Carcinoma by Left Brachial Artery Approach:Comparison with Femoral Approach

Objective To summarize the primary experiences of percutaneous puncture of left brachial artery for interventional treatments of hepatocellular carcinoma, and to compare the technical advantage and disadvantage of transbrachial approach with transfemoral approach.Methods 452 patients were divided into brachial group 52 cases and femoral group 400 cases , all patients were treated by superselective transcathter arterial chemoembolization . By comparison technical successful rate of two groups , incidence of hematoma, manipulation of microcatheter , comfort and convenience of patients , the advantage and disadvantage of two techniques were evaluated . Results Four procedures were failed in femoral group , the technical successful rate was 99.0% , which were performed by changed with the left brachial approach or left subclavian artery arrpoach . All procedures were successed in brachaial group, the technical successful rate was 100% (P>0.05 ) . Hematoma was found in 4 cases in femoral group , incidence of hematoma was 1% ; and 9 cases on brachial group , incidence was 17.3%(P<0.05). The hematoma absorbed automatically without special managements. Microcatheter was used in 75 procedures in femoral group, which were manipulated difficultly in 5 cases, incidence of difficulty was 6.7%; difficults occured in 2 case of 36 procedures in brachial group, incidence was 5.6%(P>0.05). All patients would be in bed after procedure in femoral group, with backache and lumbago, and catheters were used for urination in 23 cases. In brachial group, the patients would not be in bed after procedures, without backache and lumbago.Conclusion These data indicated that interventional treatment for hepatocellular carcinoma using the left brachial artery approach offered marked improvement in comfort and convenience for patients, which was a alternative for transfemoral approach.