肝癌TACE术中医源性肝动脉夹层的临床分析  

Iatrogenic hepatic artery dissection occurring during TACE for hepatic cancer: a clinical analysis

作　　者：熊斌[1] 阚雪峰[1] 郑传胜[1] 冯敢生[1] 叶天和[1] 李浩[1] 

机构地区：[1]武汉华中科技大学同济医学院附属协和医院介入科,430022

出　　处：《介入放射学杂志》2013年第3期198-201,共4页Journal of Interventional Radiology

摘　　要：目的 探讨TACE治疗肝癌过程出现医源性肝动脉夹层的发生率、好发部位、原因、处理策略及转归。方法 回顾性分析2011年1月至2012年6月行TACE治疗的肝癌患者1 311例次，统计术中医源性肝动脉夹层的发生率、发生部位、处理措施及转归，并分析其产生的原因。发生肝动脉夹层的患者行DSA检查随访。结果 共有12例TACE术中出现肝动脉夹层，发生率为0.92%，均系操作不慎所致。12例中8例发生于肝固有动脉起始处、3例位于肝右动脉血管扭曲处、1例位于肝总动脉，所有夹层的发生部位均为血管转折或迂曲处。12例患者中10例使用3 F微导管导丝、1例使用0.035英寸导丝通过真腔到达肝动脉靶部位，成功完成TACE；1例患者经反复尝试，仍无法通过，最后行经导管肝动脉灌注化疗术。患者随访时间3 ～ 15个月，中位随访时间8个月。嗣后血管内介入治疗的10例患者中，2例肝动脉造影时未再见夹层，其余8例均见夹层较之前不同程度缩小。结论 肝癌TACE中肝动脉夹层的发生与操作者经验、肝动脉走行等因素有关，通常可采用微导管导丝技术通过夹层段真腔而完成TACE术，其主要不良后果为影响TACE顺利完成，从而影响肝癌患者的疗效及预后，应重视其预防及处理。Objective To investigate the incidence, predilection sites, reasons, managements, outcomes and adverse effects of the iatrogenic hepatic artery dissection that occurs during the performance of transcatheter arterial chemoembolization （TACE） for hepatic malignancies. Methods The clinical data of 1 311 TACE producers, that were carried out at authors＇ hospital during the period from January 2011 to June 2012, were retrospectively analyzed. The incidence, predilection sites, managements, adverse effects and outcomes of the iatrogenic hepatic artery dissection were calculated, and the causes were analyzed. The patients who suffered from hepatic arterial dissection were followed up with DSA examination. Results Of the 1 311, iatrogenic hepatic artery dissection occurred in 12 （0.92%）. All the iatrogenic hepatic artery dissections were caused by improper manipulation. The locations of the hepatic artery dissection included proper hepatic artery （n = 8）, right hepatic artery （n = 3） and common hepatic artery （n = 1 ）. All the artery dissections were situated at the turning point of the involved arteries. Of the 12 cases, 3 F micro-catheter was employed in 10, and 0.035-inch guide-wire was used in one case, which was successfully manipulated into the targeted hepatic artery through the true arterial cavity and TACE was then accomplished. In the remaining one case the catheterization failed after repeated try in an attempt to pass through the true arterial cavity, and, finally, transcatheter hepatic arterial infusion chemotherapy had to be adopted. All the patients were followed up for 3 - 15 months, and the median follow-up time was 8 months. Of the 10 patients who received subsequent endovascular intervention therapy, hepatic angiography showed that no arterial dissection was found in 2 and different degree of the reduction of the false lumen was seen in 8. Conclusion The occurrence of hepatic artery dissection that occurs during the performance of TACE for hepatic malignancies is closely related t

关 键 词：肝癌 肝动脉 化疗栓塞 夹层 

分 类 号：R735.7[医药卫生—肿瘤]