切换至 "中华医学电子期刊资源库"
高级检索
中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2026, Vol. 14 ›› Issue (01) : 81 -88. doi: 10.3877/cma.j.issn.2095-5782.2026.01.012

技术与方法

经肱动脉入路行动脉化疗栓塞术治疗肝癌患者的舒适性、安全性及疗效研究
杨苗苗, 李菲, 宫文静†(), 刘颍†()   
  1. 264000　山东烟台，青岛大学附属烟台毓璜顶医院 肿瘤内科
  • 收稿日期:2025-05-08 出版日期:2026-02-25
  • 通信作者: 宫文静, 刘颍

A Retrospective Observational Study on the Comfort、Safety and Efficacy of Transbrachial TACE for Liver Cancer

Miaomiao Yang, Fei Li, Wenjing Gong†(), Ying Liu†()   

  1. Department of Oncology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, China
  • Received:2025-05-08 Published:2026-02-25
  • Corresponding author: Wenjing Gong, Ying Liu
  • About author:

    Co-first authors: Yang Miaomiao, Li Fei

全文 ( ) 下载PDF ( ) 导出引用
引用本文：

杨苗苗, 李菲, 宫文静, 刘颍. 经肱动脉入路行动脉化疗栓塞术治疗肝癌患者的舒适性、安全性及疗效研究[J/OL]. 中华介入放射学电子杂志, 2026, 14(01): 81-88.

Miaomiao Yang, Fei Li, Wenjing Gong, Ying Liu. A Retrospective Observational Study on the Comfort、Safety and Efficacy of Transbrachial TACE for Liver Cancer[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(01): 81-88.

目的

评价经肱动脉入路（transbrachial approach, TBA）行动脉化疗栓塞术（transarterial chemoembolization, TACE）的舒适性、安全性和初步疗效。

方法

收集2023年1月至2025年1月于烟台毓璜顶医院TBA-TACE治疗的中晚期肝癌患者的临床资料，回顾性分析肱动脉穿刺成功率、手术成功率、并发症发生率、患者舒适度以及疗效。

结果

本研究纳入300例患者，共652例次TBA-TACE治疗。经肱动脉穿刺成功率为99.39%，手术成功率为100%，并发症总发生率为2.15%，术后问卷调查显示患者满意度高。TBA-TACE术后1个月和3个月的客观缓解率分别为64.7%和46.8%，疾病控制率分别为98%和96.3%，中位无进展生存期为8.3个月。

结论

TBA-TACE治疗手术成功率高、术后并发症少，提高了患者生活质量，具有良好的初步疗效，是一种具有潜在优势的传统血管入路的替代方案。

关键词: 动脉化疗栓塞, 经肱动脉入路, 肝癌, 舒适性和安全性, 初步疗效
Objective

To investigate the safety, comfort and preliminary efficacy of transarterial chemoembolization (TACE) via transbrachial approach (TBA) in patients with intermediate-advanced liver cancer.

Methods

A retrospective observational study was conducted to collect clinical data from 300 patients with intermediate-advanced liver cancer who underwent TBA-TACE treatment at Yantai Yuhuangding Hospital from January 2023 to January 2025. The study evaluated the success rates of brachial artery puncture and subsequent procedures, complication incidence, patient-reported comfort, short-term efficacy, and progression-free survival (PFS).

Results

300 patients underwent a total of 652 TBA-TACE procedures. The success rate of brachial artery puncture was 99.39%, and the procedure success rate was 100%. The overall incidence of complications was 2.15%, and post-procedure surveys indicated high patient satisfaction. The objective response rates (ORRs) at 1 and 3 months post-procedure were 64.7% and 46.8%, respectively, while the disease control rates (DCRs) were 98% and 96.3%, respectively. The median PFS was 8.3 months.

Conclusion

TBA-TACE is associated with high technical success, a low complication rate, and high patient-reported comfort. The procedure demonstrates favorable preliminary efficacy and represents a promising alternative to traditional vascular access routes for the management of liver cancer.

Key words: Transarterial chemoembolization (TACE), Transbrachial approach (TBA), Procedure success rate, Patient comfort and safety, Preliminary efficacy
图1 通过TBA途径进行穿刺操作。 1A：穿刺部位局部麻醉；1B：以 30°至45°的角度将套管针缓慢插入肱动脉前壁；1C：动脉血流喷射后，植入导丝；1D：沿着导丝植入5F血管鞘；1E：成功植入血管鞘。1F：肱动脉穿刺置管成功。
表1 接受TBA-TACE手术的肝癌患者基线特征（n=300）
患者特征 统计结果
年龄（岁） 61.64±9.58
性别[例(%)]
男 243(81.0%)
女 57(19.0%)
高血压[例(%)]
有 84(28.0%)
无 216(72%)
糖尿病[例(%)]
有 60(20.0%)
无 240(80.0%)
脑血管病[例(%)]
有 31(10.3%)
无 269(89.7%)
肝炎病史[例(%)]
乙肝 219(73.0%)
丙肝 4(1.3%)
丁肝 1(0.3%)
戊肝 1(0.3%)
无 75(25.0%)
肝硬化[例(%)]
有 82(27.3%)
无 218(72.7%)
Child-Pugh分级[例(%)]
A 238(79.3%)
B 62(20.7%)
巴塞罗那肝癌分期（BCLC）[例(%)]
A 77(25.7%)
B 90(30.0%)
C 133(44.3%)
体能状态评分（PS）[例(%)]
0 167(55.7%)
1 130(43.3%)
2 3(1.0%)
肿瘤数目[例(%)]
1 131(43.7%)
2 32(10.7%)
≥3 127(42.3%)
最大肿瘤直径（cm） 6.1±4.5
既往治疗史[例(%)]
TACE治疗史 191(63.6%）
外科手术 147(49.0%)
内科靶免治疗 130(43.3%)
放疗 3(1.0%)
表2 TBA-TACE操作成功率、路径与时间指标（n=652）
指标 统计结果
TACE手术成功例次[例(%)] 652(100%)
TBA成功例次[例(%)] 648(99.39%)
穿刺时间（s） 10.50±2.14
置管时间（s） 41.71±9.28
左侧入路[例(%)]
右侧入路[例(%)]		 627(96.20%)
25(3.80%)
穿刺点转换例次[例(%)] 4(0.61%)
手术时间（min） 40.73±8.23
透视时间（min） 14.37±3.30
图2 肝癌患者经TBA途径化疗栓塞结果 2A：肝动脉造影显示右叶巨大的肿瘤染色；2B：在超选后，微导管到达目标动脉；2C：肿瘤供血动脉用碘化油和明胶海绵颗粒栓塞；2D：复查血管造影显示同一区域肿瘤染色消失。
表3 TBA手术相关并发症病例例次（n=652）
并发症 例次（%）
穿刺部位渗血 5(0.77%)
假性动脉瘤 2(0.31%)
正中神经损伤 1(0.15%)
皮下血肿 5(0.77%)
动脉血栓形成 1(0.15%)
表4 经桡动脉入路（TBA）在多次经肝动脉化疗栓塞（TACE）术中的可重复性和安全性分析
变量/手术次数 1次 2次 3次 4次 5次及以上
TACE手术成功[例(%)] 300(100%) 153(100%) 83(100%) 69(100%) 47(100%)
TBA成功[例(%)] 296(98.7%) 153(100%) 83(100%) 69(100%) 47(100%)
手术时间（min，
±s）		 40.73±8.23 40.71±8.37 40.70±8.92 40.69±8.95 40.68±8.92
穿刺时间（s，
±s）		 10.50±2.14 10.38±2.29 10.27±2.28 10.19±2.03 10.08±1.93
手术并发症[例(%)] 7(1.07%) 5(0.76%) 2(0.31%) 0 0
假性动脉瘤[例(%)] 1(0.15%) 1(0.15%) 0 0 0
血管痉挛[例(%)] 0 0 0 0 0
血管狭窄或闭塞[例(%)] 0 0 0 0 0
动脉血栓形成[例(%)] 1(0.15%) 0 0 0 0
穿刺部位渗血[例(%)] 3(0.46%) 2(0.31%) 0 0 0
正中神经损伤[例(%)] 0 1(0.15%) 0 0 0
皮下血肿[例(%)] 2(0.31%) 1(0.15%) 2(0.31%) 0 0
图3 TBA-TACE术后患者不适的频率分布 根据患者的反应频率分为总体不适、行走困难、如厕困难、喂养或自理困难、背痛和导管插入术部位不适。反应表示如下：无（蓝色）、轻度（浅蓝色）、中度（橙色）和重度（红色）。
图4 EORTC QLQ-30（第3版）问卷调查结果频率分布 第1~28项有4个答案，包括“完全没有”（蓝色）、“有一点”（浅蓝色）、“相当多”（橙色）和“非常多”（红色）。项目29-30与健康状况和总体生活质量有关，反应选项在1（极差）和7（优秀）之间。
表5 TBA-TACE治疗后患者近期疗效评价
随访时间 疗效，例（%） ORR DCR
CR PR SD PD
术后1个月 32(10.7%) 162(54.0%) 100(33.3%) 6(2%) 64.7% 98%
术后3个月 34(11.4%) 105(35.4%) 147(49.5%) 11(3.7%) 46.8% 96.3%
[1]
Kamya S, Jun G, Arsen O, et al. Recent advances in the management of hepatocellular carcinoma[J]. Clin Mol Hepatol, 2024, 30(1): 1-15.
[2]
Fabio P, Sadahisa O. Patient selection for transarterial chemoembolization in hepatocellular carcinoma: Importance of benefit/risk assessment[J]. Liver Cancer, 2018, 7(1): 104-119.
[3]
Ricardo Y, Stephen B, Beatriz B, et al. Transradial versus transfemoral arterial access in liver cancer embolization: Randomized trial to assess patient satisfaction[J]. J Vasc Interv Radiol, 2018, 29(1): 38-43.
[4]
Wan Y, Chen B, Li N, et al. Transradial versus transfemoral access for patients with liver cancer undergoing hepatic arterial infusion chemotherapy: Patient experience and procedural complications[J]. J Vasc Interv Radiol, 2022, 33(8): 956-963.
[5]
Lam UP, Lopes Lao EP, Lam KC, et al. Trans-brachial artery access for coronary artery procedures is feasible and safe: Data from a single-center in macau[J]. Chin Med J(Engl), 2019, 132(12): 1478-1481.
[6]
Watanabe S, Minami A, Nishioka M, et al. Left brachial approach for transcatheter arterial embolization therapy in patients with hepatocellular carcinoma[J]. Dig Dis Sci, 1997, 42(1): 47-58.
[7]
Llovet JM, Lencioni R. mRECIST for HCC: Performance and novel refinements[J]. J Hepatol, 2020, 72(2): 288-306.
[8]
You K, Guo T, Sun D, et al. Transradial versus transfemoral approach for tace: A retrospective study[J]. BMC Gastroenterol, 2023, 23(1): 11.
[9]
Roberto I, Maurizio P, Alessandro P, et al. Transradial versus transfemoral access for hepatic chemoembolization: Intrapatient prospective single-center study[J]. J Vasc Interv Radiol, 2017, 28(9): 1234-1239.
[10]
Shunichi S, Akira T, Shungo E, et al. Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: Comparison with conventional transfemoral approach[J]. J Clin Gastroenterol, 2003, 37(5): 412-417.
[11]
Chu HH, Kim JW, Shin JH, et al. Update on transradial access for percutaneous transcatheter visceral artery embolization[J]. Korean J of Radiol, 2021, 22(1): 72-85.
[12]
Lorenzo Górriz A, Rodríguez Paz C, Aguilar Tejedor Y, et al. Early exploration of the economic impact of transradial access(TRA) versus transfemoral access(TFA) for neurovascular procedures in spain[J]. J Med Econ, 2023, 26(1): 1445-1454.
[13]
Iezzi R, Posa A, Merlino B, et al. Operator learning curve for transradial liver cancer embolization: Implications for the initiation of a transradial access program[J]. Diagn Interv Radiol, 2019, 25(5): 368-374.
[14]
Ghanem I, Mesbah M, Refaat H. Safety and efficacy of brachial approach for coronary angiography and percutaneous coronary intervention[J]. Egypt Heart J, 2024, 76(1): 36.
[15]
Appelt K, Takes M, Zech CJ, et al. Complication rates of percutaneous brachial artery puncture: Effect of live ultrasound guidance[J]. CVIR Endovasc, 2021, 4(1): 74.
[16]
Tamanaha Y, Sakakura K, Taniguchi Y, et al. Comparison of postcatheterization pseudoaneurysm between brachial access and femoral access[J]. Int Heart J, 2019, 60(5): 1030-1036.
[17]
Qiu K, Liu X, Jia Z, et al. Comparing transbrachial and transradial as alternatives to transfemoral access for large-bore neuro stenting: Insights from a propensity-matched study[J]. Acad Radiol, 2025, 32(1): 326-333.
[18]
Hung ML, Lee EW, McWilliams JP, et al. A reality check in transradial access: A single-centre comparison of transradial and transfemoral access for abdominal and peripheral intervention[J]. Eur Radiol, 2019, 29(1): 68-74.
[19]
Iezzi R, Pompili M, Posa A, et al. Transradial versus transfemoral access for hepatic chemoembolization: Intrapatient prospective single-center study[J]. J Vasc Interv Radiol, 2017, 28(9): 1234-1239.
[20]
Yamada R, Bracewell S, Bassaco B, et al. Transradial versus transfemoral arterial access in liver cancer embolization: Randomized trial to assess patient satisfaction[J]. J Vasc Interv Radiol, 2018, 29(1): 38-43.
[21]
Feng G, Feng Y, Yao S, et al. Transcatheter arterial chemoembolization combined with hepatic arterial infusion chemotherapy versus transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: A systematic review and meta-analysis [J]. Turk J Gastroenterol, 2024, 35(4): 266-279.
[1] 陈系东, 王绍闯, 赵何伟, 王硕, 袁维栋. 高龄BCLC B期肝癌患者常规TACE术后急性肝功能恶化的危险因素研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 689-692.
[2] 李婷婷, 李宏羽, 吴孟航. 肝动脉灌注化疗在不可切除肝细胞癌中的应用进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 705-708.
[3] 崔梦玲, 孙文梅, 赵睿敏, 王家平. 合并微血管侵犯肝癌术后TACE联合治疗的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 160-166.
[4] 邓玉飞, 王志鑫, 娄珂, 张林轩, 马桂春, 港措. 影像组学在肝癌精准诊断、疗效评估及治疗方案决策优化中应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 172-180.
[5] 张龙, 徐伟, 孙善柯, 李文柱, 李俊达, 池涌泉, 宋进华, 王学浩, 成峰, 饶建华. 载药微球经动脉栓塞化疗在巨块型肝癌转化治疗中的疗效及安全性[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(01): 28-35.
[6] 薛伟伟, 杜凯豪, 汪占金, 东小鸽, 何洁洁, 罗兰明慧, 蒋威, 王展. 遗传学视角孟德尔随机化分析东亚人群肠道菌群与原发性肝癌因果关系[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(01): 79-88.
[7] 王利皓, 罗世超, 唐强, 尚栋良, 段少博, 卢冰, 李海, 薛飞. 仑伐替尼和PD-1抑制剂预处理联合TACE序贯治疗CNLC分期Ⅲ期肝癌疗效及安全性[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 868-874.
[8] 李健文, 陈莹, 陈羲, 宗晓丹. 钆塞酸二钠增强MRI在高分化小肝癌和不典型增生结节鉴别诊断中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 875-881.
[9] 唐玥, 陈家璐, 覃德龙, 李宗龙, 汤朝晖, 全志伟. 腹腔镜肝切除治疗复发性肝癌的焦点与难点问题探讨[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(05): 667-672.
[10] 李勃, 叶威良, 张静雯, 上文文. 叶酸-聚乙二醇-阿霉素连接物对肝癌裸鼠皮下移植瘤生长及心脏毒性影响的研究[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 101-107.
[11] 高增霞, 贺云飞, 赵娜. DCE-MRI联合Gd-EOB-DTPA MRI纹理特征对肝细胞癌经导管动脉化疗栓塞术后疗效的评估[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 108-113.
[12] 刘雪莲, 朱丹, 黄璋媚, 田卫洁, 傅娴. 原发性肝癌患者TACE联合靶向免疫治疗症状体验的质性研究[J/OL]. 中华介入放射学电子杂志, 2026, 14(01): 40-45.
[13] 孙敬文, 程晓霞, 张晶晶, 倪国庆, 王剑. 超前镇痛模式在肝动脉化疗栓塞术围手术期的应用[J/OL]. 中华介入放射学电子杂志, 2026, 14(01): 55-59.
[14] 陆涛, 李毫, 朱帝文, 鲍应军, 李一帆, 顾俊鹏, 任伟新. 乳酸脱氢酶与C反应蛋白/白蛋白比值对肝细胞癌患者经动脉化疗栓塞术预后的评估价值[J/OL]. 中华介入放射学电子杂志, 2026, 14(01): 66-71.
[15] 沈骁, 严海涛, 张金星, 祖庆泉, 刘圣, 施海彬. 基于MRI的影像组学预测TACE联合分子靶向药物及免疫检查点抑制剂治疗肝细胞癌疗效[J/OL]. 中华介入放射学电子杂志, 2026, 14(01): 72-80.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号

AI
小
编
AI小编
你好！我是《中华医学电子期刊资源库》AI小编，有什么可以帮您的吗？