超声引导经远端桡动脉入路行肝癌TACE术的临床研究

doi:10.3877/cma.j.issn.2095-5782.2023.03.010

目的

评价超声引导经远端桡动脉入路（distal transradial artery access，dTRA）行肝细胞癌（hepatocellular carcinoma，HCC）的肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）的安全性及可行性。

方法

回顾性分析2021年1月至2021年12月于我院介入科在超声引导下经左侧dTRA行TACE术的64例HCC患者的临床资料，收集dTRA穿刺成功率、穿刺时间、TACE手术成功率、TACE手术时间、术后穿刺点压迫时间、术后穿刺相关并发症。

结果

64例患者经dTRA行TACE治疗共151例次，其中单次介入操作64例次（42%，64/151），多次共87例次（58%，87/151），术前超声测量dTRA内径为（2.32 ± 0.42）（1.82~3.22）mm，经左侧dTRA穿刺成功143例（94%，143/151），穿刺时间（3.1 ± 1.9）mins，手术成功率100%（143/143），插管时间（5.7 ± 2.0）mins，手术时间（136.5 ± 54.3）mins。其中5例因导丝引入困难导致穿刺dTRA失败，术后并发症发生率为4.9%（7/143），其中穿刺点出血2例（1.4%，2/143），局部血肿或皮下瘀斑4例（2.8%，4/143），无症状桡动脉闭塞1例（0.7%，1/143），但术后3个月该患者复查显示动脉恢复通畅。

结论

超声引导下dTRA行肝癌TACE是可行、安全的。

关键词: 远端桡动脉, 超声, 原发性肝癌, TACE, 安全性

Objective

To evaluate the safety and feasibility of TACE for hepatocellular carcinoma, guided by ultrasound via the transdistal radial artery access (dTRA).

Methods

The clinical data of64 hepatocellular carcinoma patients underwent ultrasound-guided TACE through the left dTRA in our hospital from January 2021 to December 2021 were retrospectively analyzed and the dTRA puncture success rate, puncture time, TACE operation success rate, TACE operation time, postoperative puncture point compression time, and postoperative puncture-related complications were collected.

Results

The 64 patients were treated with TACE by dTRA for 151 cases. Of these, there were 64 single intervention cases (42%, 64/151) and 87 multiple intervention cases (58%, 87/151). The preoperative ultrasound measurement of dTRA was (2.32 ± 0.42) (1.82~3.22) mm. There were 143 successful left dTRA puncture cases (94%, 143/151). The puncture time was (3.1 ± 1.9) mins. The surgical success rate is 100% (143/143). The intubation time was (5.7 ± 2.0) mins. The operative time was (136.5 ± 54.3) mins. Five cases failed to puncture dTRA due to difficulties in guidewire introduction, with a postoperative complication rate of 4.9% (7/143), including2 puncture point bleeding (1.4%, 2/143), 4 local hematoma or subcutaneous ecchymosis (2.8%, 4/143), and 1 asymptomatic RAO (0.7%, 1/143). However, three months after surgery, the patient's artery had recovered patency.

Conclusions

TACE for hepatocellular carcinoma by ultrasound-guided dTRA is feasible and safe.

Key words: Distal radial artery, Ultrasound, Hepatocellular carcinoma, TACE, Safety

图1 远绕动脉穿刺手摆放与穿刺点。鼻咽窝区穿刺点：由桡侧的拇长展肌腱、拇短伸肌腱与尺侧拇长伸肌腱围成的三角形凹陷内（黑线区域为鼻咽窝区，黑点标记为穿刺点）；第一掌骨间隙穿刺点：第1、2掌骨的"径向顶点"。（红线区域为第一掌骨间隙，红点标记为穿刺点）

图2 远端桡动脉超声图像2A：第一掌骨间隙穿刺点超声图像；2B：鼻咽窝区穿刺点超声图像，箭头为远端桡动脉，三角形为拇指基底部及食指掌骨，星号为舟状骨。

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Clinical study of TACE for hepatocellular carcinoma by ultrasound-guided transdistal radial artery approach

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Clinical study of TACE for hepatocellular carcinoma by ultrasound-guided transdistal radial artery approach