经桡动脉和股动脉路径肝动脉化疗栓塞术治疗肝恶性肿瘤的回顾性队列研究

doi:10.3877/cma.j.issn.2095-5782.2025.03.005

中华介入放射学电子杂志 ›› 2025, Vol. 13 ›› Issue (03) : 222 -227. doi: 10.3877/cma.j.issn.2095-5782.2025.03.005

肿瘤介入

经桡动脉和股动脉路径肝动脉化疗栓塞术治疗肝恶性肿瘤的回顾性队列研究

刘娜¹, 于长辉², 彭波², 石红建³, 甘振¹^,³^,^†(

)

¹　845350　新疆　阿图什市，克孜勒苏柯尔克孜自治州人民医院介入治疗中心
²　845350　新疆　阿图什市，克孜勒苏柯尔克孜自治州人民医院心胸外科
³　210011　江苏　南京，南京医科大学第二附属医院介入血管外科

收稿日期:2024-11-28 出版日期:2025-08-25
通信作者: 甘振
基金资助:
克孜勒苏柯尔克孜自治州科研创新项目(2024-46)

Retrospective cohort study of transarterial chemoembolization for hepatic malignant tumors via transradial and transfemoral access

Na LIU¹, Chang-hui YU², Bo PENG², Hong-jian SHI³, Zhen GAN¹^,³^,^†()

¹ Department of Interventional Centre, People's Hospital of Kizilsu Kirgiz Autonomous Prefecture, Atushi, Xinjiang Province 845350, China
² Department of Cardiothoracic Surgery, People's Hospital of Kizilsu Kirgiz Autonomous Prefecture, Atushi, Xinjiang Province 845350, China
³ Department of Interventional Radiology and Vascular Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210011, China

Received:2024-11-28 Published:2025-08-25
Corresponding author: Zhen GAN

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引用本文：

刘娜, 于长辉, 彭波, 石红建, 甘振. 经桡动脉和股动脉路径肝动脉化疗栓塞术治疗肝恶性肿瘤的回顾性队列研究[J/OL]. 中华介入放射学电子杂志, 2025, 13(03): 222-227.

Na LIU, Chang-hui YU, Bo PENG, Hong-jian SHI, Zhen GAN. Retrospective cohort study of transarterial chemoembolization for hepatic malignant tumors via transradial and transfemoral access[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2025, 13(03): 222-227.

目的

评估经桡动脉路径（transradial access, TRA）和经股动脉路径（transfemoral access, TFA）肝动脉化疗栓塞术(transarterial chemoembolization, TACE)治疗肝恶性肿瘤安全性和近期疗效。

方法

回顾性分析2021年10月至2023年12月南京医科大学第二附属医院介入血管外科与克孜勒苏柯尔克孜自治州人民医院介入治疗中心开展经TRA TACE和既往TFA TACE治疗的43例肝恶性肿瘤患者的临床资料。主要观察终点为2组介入治疗技术成功率，介入治疗相关并发症和不良反应；次要观察终点为2组术后近期疗效和术中剂量相关指标。

结果

TRA组42例成功行桡动脉穿刺置管及靶血管插管，技术成功率为97.7%，TFA组技术成功率100%，差异无统计学意义（P>0.05）。TRA组和TFA组介入治疗相关并发症和不良反应发生率比较，差异均无统计学意义（2.3%比9.3%，79.1% 比 74.4%；P>0.05）。TRA组和TFA组术中透视时间比较，差异有统计学意义[12(10, 15) min比10(8, 12) min; P<0.001]；TRA组和TFA组累积剂量和剂量面积比较，差异无统计学意义[567(412, 760) mGy 比 481(390, 670) mGy；191(152, 288) Gy·cm²比188(141, 220) Gy·cm²; P>0.05]。2组近期疗效比较，差异无统计学意义（P>0.05）。

结论

TRA TACE治疗肝恶性肿瘤的安全性和近期疗效与TFA TACE相当，TRA TACE虽然会延长透视时间，但是并不增加射线剂量。

关键词: 肝动脉化疗栓塞术, 肝恶性肿瘤, 经桡动脉路径, 经股动脉路径

Objective

To evaluate the safety and the short-term effect of TACE in treating hepatic malignant tumor via TRA and TFA.

Methods

This retrospective study analyzed 43 patients with hepatic malignancies treated at the authors' institutions between October 2021 and December 2023. All patients underwent TRA TACE following prior TFA TACE. The primary endpoints were the technical success, the complications and the adverse events. The secondary endpoints were the short-term effect and the dose-related indexes.

Results

Radial artery and target vessel catheterization were successfully performed in 42 cases in the TRA group, of which the technical success rate was 97.7%. The technical success rate of the TFA group was 100%, and the difference between the two group was not significant (P>0.05). The incidence of the complications and the adverse events in the TRA group and the TFA group were 2.3%vs.9.3% and 79.1%vs.74.4%, respectively, with no significant difference (P>0.05). The fluoroscopy time, the accumulative dose, and the dose area product in the TRA group and the TFA group were 12(10, 15) min vs. 10(8, 12) min; 567(412, 760) mGy vs. 481(390, 670) mGy; 191(152, 288) Gy×cm²vs. 188(141, 220) Gy×cm², respectively. The difference of the fluoroscopy time between the two groups was significant(P<0.001). The short-term effect of the two groups was comparable, with no significant difference(P>0.05).

Conclusion

The safety and the short-term effect of TRA TACE in treating hepatic malignant tumor are comparable to TFA TACE. Although TRA TACE may increase the fluoroscopy time, it may not increase the radiation dose.

Key words: Transarterial chemoembolization, Hepatic malignant tumor, Transradial access, Transfemoral access

图1 研究流程图 TRA: 桡动脉路径; TFA: 股动脉路径; DEB-TACE：行载药微球-肝动脉化疗栓塞术。

表1 2组患者基线资料比较

组别	例数	男性 [例(%)]	年龄 (年, $x ¯ ± s$ )	病理类型 [例(%)]			治疗间隔(个月, $x ¯ ± s$ )	ECOG-PS评分[例(%)]			Child-Pugh评分 [例(%)]				ALBI分级 [例(%)]
组别	例数	男性 [例(%)]	年龄 (年, $x ¯ ± s$ )	HCC	ICC	MHC	治疗间隔(个月, $x ¯ ± s$ )	0分	1分	2分	5分	6分	7分	8分	1级	2级
TRA组	43	38 (88.4)	65.3±10.7	29 (67.4)	2 (4.7)	12 (27.9)	4.0±2.9	11 (25.6)	31 (72.1)	1 (2.3)	33 (76.7)	7 (16.3)	2 (4.7)	1 (2.3)	30 (69.8)	13 (30.2)
TFA组	43	38 (88.4)	65.3±10.7	29 (67.4)	2 (4.7)	12 (27.9)	4.0±2.9	11 (25.6)	28 (65.1)	4 (9.3)	30 (69.8)	9 (20.9)	4 (9.3)	0 (0.0)	28 (65.1)	15 (34.9)
P值								0.496			0.795				0.818

表1 2组患者基线资料比较

组别	例数	男性 [例(%)]	年龄 (年, $x ¯ ± s$ )	病理类型 [例(%)]			治疗间隔(个月, $x ¯ ± s$ )	ECOG-PS评分[例(%)]			Child-Pugh评分 [例(%)]				ALBI分级 [例(%)]
组别	例数	男性 [例(%)]	年龄 (年, $x ¯ ± s$ )	HCC	ICC	MHC	治疗间隔(个月, $x ¯ ± s$ )	0分	1分	2分	5分	6分	7分	8分	1级	2级
TRA组	43	38 (88.4)	65.3±10.7	29 (67.4)	2 (4.7)	12 (27.9)	4.0±2.9	11 (25.6)	31 (72.1)	1 (2.3)	33 (76.7)	7 (16.3)	2 (4.7)	1 (2.3)	30 (69.8)	13 (30.2)
TFA组	43	38 (88.4)	65.3±10.7	29 (67.4)	2 (4.7)	12 (27.9)	4.0±2.9	11 (25.6)	28 (65.1)	4 (9.3)	30 (69.8)	9 (20.9)	4 (9.3)	0 (0.0)	28 (65.1)	15 (34.9)
P值								0.496			0.795				0.818

表2 2组患者主要观察终点比较

组别	例数	技术成功[例(%)]	介入手术相关并发症[例(%)]				CIRSE分级[例(%)]		介入治疗不良反应[例(%)]							3级不良反应[例(%)]
组别	例数	技术成功[例(%)]	穿刺部位血肿	假性动脉瘤	动脉闭塞	合计	1级	2或3级	疲乏	发热	恶心呕吐	腹痛	便秘	骨髓抑制	合计	3级不良反应[例(%)]
TRA组	43	42 (97.7)	0 (0.0)	0 (0.0)	1 (2.3)	1 (2.3)	0 (0.0)	1 (2.3)	16 (37.2)	18 (41.9)	15 (34.9)	24 (55.8)	3 (7.0)	6 (14.0)	34 (79.1)	3 (7.0)
TFA组	43	43 (100.0)	3 (7.0)	1 (2.3)	0 (0.0)	4 (9.3)	3 (7.0)	1 (2.3)	18 (41.9)	15 (34.9)	14 (32.6)	20 (46.5)	5 (11.6)	5 (11.6)	32 (74.4)	2 (4.7)
P值		0.999	0.357				0.400		0.659	0.506	0.820	0.388	0.458	0.747	0.610	0.645

表2 2组患者主要观察终点比较

组别	例数	技术成功[例(%)]	介入手术相关并发症[例(%)]				CIRSE分级[例(%)]		介入治疗不良反应[例(%)]							3级不良反应[例(%)]
组别	例数	技术成功[例(%)]	穿刺部位血肿	假性动脉瘤	动脉闭塞	合计	1级	2或3级	疲乏	发热	恶心呕吐	腹痛	便秘	骨髓抑制	合计	3级不良反应[例(%)]
TRA组	43	42 (97.7)	0 (0.0)	0 (0.0)	1 (2.3)	1 (2.3)	0 (0.0)	1 (2.3)	16 (37.2)	18 (41.9)	15 (34.9)	24 (55.8)	3 (7.0)	6 (14.0)	34 (79.1)	3 (7.0)
TFA组	43	43 (100.0)	3 (7.0)	1 (2.3)	0 (0.0)	4 (9.3)	3 (7.0)	1 (2.3)	18 (41.9)	15 (34.9)	14 (32.6)	20 (46.5)	5 (11.6)	5 (11.6)	32 (74.4)	2 (4.7)
P值		0.999	0.357				0.400		0.659	0.506	0.820	0.388	0.458	0.747	0.610	0.645

表3 2组患者次要观察终点和其他观察指标比较

组别	例数	透视时间[min, M(Q₁，Q₃)]	累积剂量[mGy, M(Q₁，Q₃)]	剂量面积[Gy·cm², M(Q₁，Q₃)]	碘化油用量[mL, M(Q₁，Q₃)]	肝内病灶疗效评估 [例(%)]		住院时间[d, M(Q₁，Q₃)]	住院费用 (万元, $x ¯ ± s$ )
组别	例数	透视时间[min, M(Q₁，Q₃)]	累积剂量[mGy, M(Q₁，Q₃)]	剂量面积[Gy·cm², M(Q₁，Q₃)]	碘化油用量[mL, M(Q₁，Q₃)]	ORR	DCR	住院时间[d, M(Q₁，Q₃)]	住院费用 (万元, $x ¯ ± s$ )
TRA组	43	12 (10, 15)	567 (412, 760)	191 (152, 288)	4 (3, 6)	19 (44.2)	32 (74.4)	9 (7, 11)	2.8 ± 0.8
TFA组	43	10 (8, 12)	481 (390, 670)	188 (141, 220)	5 (2.5, 6)	22 (51.2)	33 (76.7)	8 (7, 11)	2.7 ± 0.7
P值		<0.001	0.063	0.279	0.901	0.517	0.802	0.490	0.629

表3 2组患者次要观察终点和其他观察指标比较

组别	例数	透视时间[min, M(Q₁，Q₃)]	累积剂量[mGy, M(Q₁，Q₃)]	剂量面积[Gy·cm², M(Q₁，Q₃)]	碘化油用量[mL, M(Q₁，Q₃)]	肝内病灶疗效评估 [例(%)]		住院时间[d, M(Q₁，Q₃)]	住院费用 (万元, $x ¯ ± s$ )
组别	例数	透视时间[min, M(Q₁，Q₃)]	累积剂量[mGy, M(Q₁，Q₃)]	剂量面积[Gy·cm², M(Q₁，Q₃)]	碘化油用量[mL, M(Q₁，Q₃)]	ORR	DCR	住院时间[d, M(Q₁，Q₃)]	住院费用 (万元, $x ¯ ± s$ )
TRA组	43	12 (10, 15)	567 (412, 760)	191 (152, 288)	4 (3, 6)	19 (44.2)	32 (74.4)	9 (7, 11)	2.8 ± 0.8
TFA组	43	10 (8, 12)	481 (390, 670)	188 (141, 220)	5 (2.5, 6)	22 (51.2)	33 (76.7)	8 (7, 11)	2.7 ± 0.7
P值		<0.001	0.063	0.279	0.901	0.517	0.802	0.490	0.629

图2 2组剂量相关指标 TRA: 桡动脉路径; TFA: 股动脉路径。

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Retrospective cohort study of transarterial chemoembolization for hepatic malignant tumors via transradial and transfemoral access

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Retrospective cohort study of transarterial chemoembolization for hepatic malignant tumors via transradial and transfemoral access