肝细胞癌患者的跨径向获取化疗
Summary
跨动脉化疗 （TACE） 是治疗肝细胞癌中间阶段患者的标准疗法，通常通过股动脉进行。与跨性别接触相比，跨径接触（TRA）可以降低出血并发症的发生率，提高患者的耐受性。这里介绍了一种通过径向动脉访问进行跨动脉化疗的方法。
Abstract
跨动脉化疗 （TACE） 是治疗中间阶段肝细胞癌 （HCC） 的最常见方式。TACE 通常通过跨性别访问 （TFA） 执行。然而，由于并发症和死亡率的降低，冠状动脉干预中优先使用横向通道 （TRA）。TRA 的优势是否可以应用于 TACE 需要调查。
在单个中心接受TRA TACE的患者被追溯性地注册学习。对程序细节、技术成功、径向动脉闭塞率（RAO）和访问部位相关的出血并发症进行了评估。从 2017 年 10 月到 2018 年 10 月，112 名患者接受了 160 例 TRA TACE 手术。总体技术成功率为95.0%（152/160）。从特拉到 Tfa 的交叉率为 1.9%。在任何情况下均未发现与访问站点相关的出血并发症。无症状RA闭塞发生在三个患者（2.7%）。与 TFA 相比，TRA 可提高安全性和患者满意度，同时减少与访问部位相关的出血并发症。此外，TRA 干预措施可使老年、肥胖或出血并发症的高危患者受益。
Introduction
肝细胞癌（HCC）是一种非常常见的恶性肿瘤，发病率居世界第六位。这也是全球癌症死亡率的第二大原因。因为只有5%-20%的患者可以接受治疗，跨动脉化疗（TACE）是HCC2患者最流行的姑息治疗。TACE 已被公认为中度3期 HCC 患者最常用和最有效的治疗方法。跨女性获取 （TFA） 化疗是 TACE4最常见的方法。然而，有与TFA干预相关的风险，包括进入现场出血和主要血管并发症5。这些并发症导致长期住院和增加费用。此外，TFA 要求固定至少 6 小时，这增加了患者的不适和不满。
跨径向访问 （TRA） 是一种替代方法，已用于皮下冠状动脉干预 （PCI） 超过20年 5，6。TRA PCI有几个优点：增加手术舒适性，减少接触部位相关的出血，减少主要血管并发症，降低死亡率7，8。径向动脉（RA）是很容易访问和穿刺，因为它的表面位置7。血吸虫病易于干预后进行，没有严格的熏蒸9。尽管在心脏导管治疗方面有令人鼓舞的 TRA 干预证据，但迄今为止，只有少数研究在周围疾病干预中使用了 TRA。恶性肝肿瘤的TRA干预更为罕见。分析了TRA肝栓塞的临床可行性和安全性。还介绍了一个机构在提供分步 TRA 协议方面的经验。
Protocol
这项单中心回顾性研究得到了复旦大学中山医院地方机构评审委员会的批准。 1. 获得知情同意 在TRA干预之前，请介入放射科医生（IRs）向患者解释TRA的好处和潜在的并发症。 2. 患者评价 在获得知情同意后，评估 RA 的穿刺和罐装的可行性。 全面回顾患者的病史。确认患者是否患有严重的血管结肠炎、严重的周围血…
Representative Results
2017年10月至2018年10月，112名患者接受了160例TRA TACE手术，总体技术成功率为95.0%（152/160）。有8个案件出现技术故障。其中5例是由左RA穿刺失败引起的，随后在右RA访问下成功进行了TACE。其他三个病例是由禁食失败引起的，随后通过交叉到右足总访问成功干预。RA 访问 FA 访问的交叉率仅为 1.9%。在任何病例中均未发现与出入部位相关的出血并发症。 比较了技术成功或技术故障?…
Discussion
近年来，TRA介入疗法在全球显著增长，特别是在诊断和介入心脏病学程序12。此外，人们越来越重视外周血管疾病干预。在不影响程序成功率的情况下，TRA到心脏干预可以有效地降低出血率和血管并发症相比，TFA13，14。与 TFA 相比，TRA 在多个能力方面都更胜一筹，包括手术后的监测时间、消沉时间以及更高的患者总体满意度 15、16、17?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
这项工作得到了复旦大学中山医院临床研究专项基金（2016ZSLC17）的支持。作者非常感谢复旦大学中山医院胡祥林博士对英语写作的专业建议。
Materials
| Reagents | |||
| Embosphere | Merit | 20173776165 | |
| Gelfoam | Alicon | 20143771056 | |
| Heparin | Hepatunn | H51021209 | |
| Injection syringe | KDL | 20163150518 | |
| Iodinated oil | Yantai Luyin Pharmaceutical Co.Ltd | H37022398 | |
| Lidocaine | Shandong Hualu Pharmaceutical Co.Ltd | H37022147 | |
| Lobaplatin | Hainan Changan International Pharmaceutical Co.Ltd | H20050308 | |
| Nitroglycerin | Brijing Yimin Pharmaceutical Co.Ltd | H11020289 | |
| Normal saline | Anhui Shuanghe Pharmaceutical Co.Ltd | H34023609 | |
| Pharmorubicin | Pfizer | H20000496 | |
| Ultravist 370 | Bayer | H20171333 | |
| Material | |||
| Hydrophilic Guide Wire | Merit | LWSTDA38180 | |
| Injection syringe | KDL | 20163150518 | |
| Maestro Microcatheter | Merit | 28MC24150SN | |
| MPA1 (I) catheter | Cordis | 451-406P0 | |
| Sheath Introducer | Merit | PSI-4F-11-035 | |
| Steerable Guidewire | Merit | TNR2411 | |
| TR Band | Terumo | XX*RF06 | |
| Equipment | |||
| DSA | Toshiba | INFX-9000V | |
| Ultrasonic machine | SonoScape | 20172231180 |
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Cite This Article
Du, N., Ma, J., Yang, M., Zhang, Z., Zheng, Z., Zhang, W., Yan, Z. Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients. J. Vis. Exp. (163), e61109, doi:10.3791/61109 (2020).