改良式经皮肝动脉化疗药盒植入技术中国专家共识(2022版)

中国抗癌协会肿瘤介入学专业委员会; 中国抗癌协会肿瘤介入学专业委员会化疗与免疫治疗分委会

改良式经皮肝动脉化疗药盒植入技术中国专家共识(2022版)

基金项目:

北京市医管局“扬帆”计划重点医学专业项目 (ZYLX202117);

国家自然科学基金 (82172039)

王晓东(北京大学肿瘤医院)，xiaodongw75@yahoo.com；杨仁杰(北京大学肿瘤医院)，renjieyang2007@163.com；邹英华(北京大学第一医院)，cjr.zouyinghua@vip.163.com

计量
- 文章访问数: 642
- HTML全文浏览量: 516
- PDF下载量: 161
- 被引次数: 0
出版历程
- 收稿日期: 2022-09-24
- 录用日期: 2022-10-13
- 出版日期: 2022-11-20

Chinese expert consensus on the modified implantation technique of port-catheter system for percutaneous hepatic arterial infusion chemotherapy(version 2022)

Research funding:

Key Medical Specialty Development Program (Yangfan Program) of Beijing Hospital Authority (ZYLX202117);

National Natural Science Foundation of China (82172039)

摘要

摘要: 近年来，肝动脉灌注化疗(HAIC)作为介入治疗技术之一，应用于治疗进展期肝胆恶性肿瘤的效果逐渐受到认可。但不同临床中心的HAIC操作技术差别较大，缺乏行业规范，且多数以一次性穿刺留管形式完成。为了满足HAIC需长时间持续灌注、多次反复给药的特点，经皮肝动脉化疗药盒系统比一次性穿刺留管更具优势。改良式经皮肝动脉化疗药盒系统植入术采用管头固定技术、肝内外血流再分布术，具有创伤小、导管移位率低、实现全肝灌注、患者舒适性高、并发症少等优点，已在国内外多个临床中心得以证实。为了更好地规范HAIC治疗技术，通过回顾文献并经临床实践和充分讨论，参与本共识编写专家达成改良式经皮肝动脉化疗药盒植入术标准化操作流程、技术要点、HAIC方案、术后并发症防治、药盒系统维护及相关护理常规等共识。
- 改良式经皮肝动脉化疗药盒植入术 /
- 肝动脉灌注化疗 /
- 肝胆系统恶性肿瘤 /
- 专家共识
Abstract: In recent years,hepatic arterial infusion chemotherapy(HAIC),as one of the interventional therapeutic techniques,has been gradually recognized in the treatment of advanced hepatobiliary malignancies. However,HAIC operation technique has no unified standard and varies widely in different clinical centers. Usually,in most clinical centers HAIC is performed in a way of pure puncture plus catheter implantation. In order to meet the requirements of long and continuous arterial infusion and repeated drug administration in HAIC treatment,the use of modified percutaneous hepatic arterial port-catheter system is superior to conventional repeated femoral arterial puncture and catheterization. In the implantation of hepatic arterial port-catheter system,the modified fixed-catheter-tip technique and the intra-hepatic and extra-hepatic arterial blood flow redistribution technique are adopted,these techniques have the advantages of small trauma,low catheter displacement rate,achieving the purpose of whole liver perfusion,higher patient comfort,fewer complications,etc.,which have already been demonstrated in many clinical centers at home and abroad. In order to better standardize the treatment technique of HAIC,the experts who participate in compiling this consensus,through reviewing the literature,combining own clinical practice experience and making full discussion,have reached following agreements concerning the standardized operation process,technical key points,HAIC regimen,prevention and treatment of postoperative complications,maintenance of port-catheter system and related nursing routines.

HTML全文

图 1 肝外血流再分布术

注：▲①腹腔动脉造影示胃右动脉(白虚线箭)从肝左动脉起始部发出，副胃左动脉(白实线箭)从肝左动脉二级分支处发出；②采用微弹簧圈超选择行胃右动脉和副胃左动脉(黑虚线箭)栓塞，胃十二指肠动脉(gastroduodenal artery，GDA)固定管头时栓塞(橙色箭)，经药盒留置导管行肝动脉造影显示肝动脉分支显示完全，未见胃肠道动脉分支显示；▲③腹腔动脉造影示肝固有动脉发出十二指肠后上动脉(白实线箭)和胃右动脉(白虚线箭)；④采用微弹簧圈超选择行胃右动脉和十二指肠后上动脉(黑虚线箭)栓塞，GDA固定管头时栓塞(橙色箭)，经药盒留置导管行肝动脉造影示肝动脉分支显示完全，未见胃肠道动脉分支显示；▲经胃左动脉逆行栓塞胃右动脉：⑤经胃左动脉(白虚线箭)逆行超选择微导管至胃右动脉起始部(白实线箭)造影示胃右动脉；⑥微弹簧圈栓塞胃右动脉(黑实线箭)，经药盒行肝动脉造影示胃右动脉闭塞，肝动脉显示完全。

Figure 1. Extrahepatic blood flow redistribution

下载: 全尺寸图片幻灯片

图 2 肝内血流再分布术

注：①腹腔动脉造影示副肝左动脉(白箭)从胃左动脉发出；②微弹簧圈栓塞变异的副肝左动脉(白虚线箭)后，经药盒留置导管造影示肝固有动脉供血全肝；③术中肝总动脉造影示肝总动脉仅发出部分肝动脉；④肠系膜上动脉造影示副肝右动脉(白箭)从肠系膜上动脉发出；⑤胃左动脉造影示副肝左动脉(黑箭)从胃左动脉发出；⑥微弹簧圈分别栓塞副肝右动脉(白虚线箭)和副肝左动脉(黑虚线箭)后，经药盒留置导管造影示肝固有动脉供血全肝。

Figure 2. Intrahepatic blood flow redistribution

下载: 全尺寸图片幻灯片

图 3 管头固定技术模式图

Figure 3. Fixed-catheter-tip technical pattern

下载: 全尺寸图片幻灯片

图 4 管头固定技术

注：①留置导管远端(白实线箭)选择性进入GDA，微导管(黑实线箭)通过留置导管侧孔(白箭头)进入GDA；②通过微导管在GDA内、留置导管远端(黑箭头)外侧，密集释放微弹簧圈(白箭头)；③微导管导丝(黑实线箭)通过留置导管(黑箭头)内腔，进入GDA；④通过微导管释放微弹簧圈(黑实线箭)，封堵留置导管远端端孔(白箭头)；⑤⑥栓塞固定留置导管远端于GDA(白实线箭)的同时栓塞胰十二指肠后上动脉(黑实线箭和黑虚线箭)。

Figure 4. Fixed-catheter-tip technique

下载: 全尺寸图片幻灯片

图 5 药盒埋置位置

注：①股动脉入路；②锁骨下动脉入路。

Figure 5. Position of the implantation of port-catheter system

下载: 全尺寸图片幻灯片

图 6 DSA和CTHA造影明确药盒功能状态

注：①②经药盒行肝动脉DSA和CTHA造影显示肝脏灌注完全，未见肝外异常灌注。

Figure 6. Functional status of port-catheter system determined by DSA and CTHA

下载: 全尺寸图片幻灯片

参考文献(37)

[1]	KONSTANTINIDIS IT, GROOT KOERKAMP B, DO RK, et al. Unresectable intrahepatic cholangiocarcinoma: Systemic plus hepatic arterial infusion chemotherapy is associated with longer survival in comparison with systemic chemotherapy alone[J]. Cancer, 2016, 122(5): 758-765. DOI: 10.1002/cncr.29824.
[2]	DHIR M, JONES HL, SHUAI Y, et al. Hepatic arterial infusion in combination with modern systemic chemotherapy is associated with improved survival compared with modern systemic chemotherapy alone in patients with isolated unresectable colorectal liver metastases: A case-control study[J]. Ann Surg Oncol, 2017, 24(1): 150-158. DOI: 10.1245/s10434-016-5418-6.
[3]	CHAN DL, ALZAHRANI NA, MORRIS DL, et al. Systematic review and meta-analysis of hepatic arterial infusion chemotherapy as bridging therapy for colorectal liver metastases[J]. Surg Oncol, 2015, 24(3): 162-171. DOI: 10.1016/j.suronc.2015.06.014.
[4]	WANG X, HU J, CAO G, et al. Phase Ⅱ study of hepatic arterial infusion chemotherapy with oxaliplatin and 5-fluorouracil for advanced perihilar cholangiocarcinoma[J]. Radiology, 2017, 283(2): 580-589. DOI: 10.1148/radiol.2016160572.
[5]	KONSTANTINIDIS IT, DO RK, GULTEKIN DH, et al. Regional chemotherapy for unresectable intrahepatic cholangiocarcinoma: a potential role for dynamic magnetic resonance imaging as an imaging biomarker and a survival update from two prospective clinical trials[J]. Ann Surg Oncol, 2014, 21(8): 2675-2683. DOI: 10.1245/s10434-014-3649-y.
[6]	ZHENG K, ZHU X, FU S, et al. Sorafenib plus hepatic arterial infusion chemotherapy versus sorafenib for hepatocellular carcinoma with major portal vein tumor thrombosis: a randomized trial[J]. Radiology, 2022, 303(2): 455-464. DOI: 10.1148/radiol.211545.
[7]	LYU N, WANG X, LI JB, et al. Arterial chemotherapy of oxaliplatin plus fluorouracil versus sorafenib in advanced hepatocellular carcinoma: a biomolecular exploratory, randomized, phase Ⅲ trial (FOHAIC-1)[J]. J Clin Oncol, 2022, 40(5): 468-480. DOI: 10.1200/JCO.21.01963.
[8]	LI QJ, HE MK, CHEN HW, et al. Hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin versus transarterial chemoembolization for large hepatocellular carcinoma: A randomized phase Ⅲ trial[J]. J Clin Oncol, 2022, 40(2): 150-160. DOI: 10.1200/JCO.21.00608.
[9]	HE M, LI Q, ZOU R, et al. Sorafenib plus hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion: A randomized clinical trial[J]. JAMA Oncol, 2019, 5(7): 953-960. DOI: 10.1001/jamaoncol.2019.0250.
[10]	LIU B, ZHU X, GAO S, et al. Safety and efficacy of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin post-transarterial chemoembolization for unresectable hepatocellular carcinoma[J]. J Interv Med, 2019, 2(2): 91-96. DOI: 10.1016/j.jimed.2019.07.006.
[11]	ZHAO Y, LAI J, LIANG R, et al. Sorafenib plus hepatic arterial infusion chemotherapy with oxaliplatin versus sorafenib alone for advanced hepatocellular carcinoma[J]. J Interv Med, 2019, 2(2): 78-83. DOI: 10.1016/j.jimed.2019.07.005.
[12]	ZHAO DX, ZHANG L, JIANG XQ, et al. Is HAIC an obsolete technology or a novel therapeutic method? HAIC should be treated rationally[J]. J Intervent Radiol, 2022, 31(1): 2-8. DOI: 10.3969/j.issn.1008-794X.2022.01.001. 赵东旭, 张磊, 姜小庆, 等. HAIC是老技术还是新方法——理性看待肝动脉灌注化疗[J]. 介入放射学杂志, 2022, 31(1): 2-8. DOI: 10.3969/j.issn.1008-794X.2022.01.001.
[13]	YAMAGAMI T, ⅡDA S, KATO T, et al. Using n-butyl cyanoacrylate and the fixed-catheter-tip technique in percutaneous implantation of a port-catheter system in patients undergoing repeated hepatic arterial chemotherapy[J]. AJR Am J Roentgenol, 2002, 179(6): 1611-1617. DOI: 10.2214/ajr.179.6.1791611.
[14]	MAHNKEN AH, PEREIRA PL, de BAÈRE T. Interventional oncologic approaches to liver metastases[J]. Radiology, 2013, 266(2): 407-430. DOI: 10.1148/radiol.12112544.
[15]	de BAERE T, MARIANI P. Surgical or percutaneous hepatic artery cannulation for chemotherapy[J]. J Visc Surg, 2014, 151 (Suppl 1): S17-S20. DOI: 10.1016/j.jviscsurg.2013.12.004.
[16]	KOGANEMARU M, ABE T, IWAMOTO R, et al. Hepatic arterial infusion chemotherapy with a coaxial reservoir system using a non-braided spiral tip microcatheter[J]. Jpn J Radiol, 2012, 30(1): 10-17. DOI: 10.1007/s11604-011-0001-3.
[17]	SINN M, NICOLAOU A, RICKE J, et al. Interventionally implanted port catheter systems for hepatic arterial infusion of chemotherapy in patients with primary liver cancer: a phase Ⅱ-study (NCT00356161)[J]. BMC Gastroenterol, 2013, 13: 125. DOI: 10.1186/1471-230X-13-125.
[18]	HILDEBRANDT B, PECH M, NICOLAOU A, et al. Interventionally implanted port catheter systems for hepatic arterial infusion of chemotherapy in patients with colorectal liver metastases: a Phase Ⅱ-study and historical comparison with the surgical approach[J]. BMC Cancer, 2007, 7: 69. DOI: 10.1186/1471-2407-7-69.
[19]	DESCHAMPS F, ELIAS D, GOERE D, et al. Intra-arterial hepatic chemotherapy: a comparison of percutaneous versus surgical implantation of port-catheters[J]. Cardiovasc Intervent Radiol, 2011, 34(5): 973-979. DOI: 10.1007/s00270-010-9996-6.
[20]	ZHAN YJ, CHENG YD. Percutaneous intravascular post-catheter system implantation[J]. J Intervent Radiol, 1998, 7(4): 211-213. https://www.cnki.com.cn/Article/CJFDTOTAL-JRFS199804007.htm 詹迎江, 程永德. 锁骨下动脉经皮导管药盒系统植入法的临床应用[J]. 介入放射学杂志, 1998, 7(4): 211-213. https://www.cnki.com.cn/Article/CJFDTOTAL-JRFS199804007.htm
[21]	SEKI H, OZAKI T, SHⅡNA M. Side-hole catheter placement for hepatic arterial infusion chemotherapy in patients with liver metastases from colorectal cancer: long-term treatment and survival benefit[J]. AJR Am J Roentgenol, 2008, 190(1): 111-120. DOI: 10.2214/ajr.07.2038.
[22]	HU J, ZHU X, WANG X, et al. Evaluation of percutaneous unilateral trans-femoral implantation of side-hole port-catheter system with coil only fixed-catheter-tip for hepatic arterial infusion chemotherapy[J]. Cancer Imaging, 2019, 19(1): 15. DOI: 10.1186/s40644-019-0202-z.
[23]	MATSUMOTO T, YAMAGAMI T, YOSHIMATSU R, et al. Hepatic arterial infusion chemotherapy by the fixed-catheter-tip method: retrospective comparison of percutaneous left subclavian and femoral port-catheter system implantation[J]. AJR Am J Roentgenol, 2014, 202(1): 211-215. DOI: 10.2214/AJR.12.10502.
[24]	YAMAGAMI T, YOSHIMATSU R, MATSUMOTO T, et al. Evaluation of non-target arterial patency after implantation of hepatic arterial catheter using a modified implantation technique with the fixed catheter tip method[J]. Clin Radiol, 2009, 64(2): 164-170. DOI: 10.1016/j.crad.2008.06.016.
[25]	HU J, BAO Q, CAO G, et al. Hepatic arterial infusion chemotherapy using oxaliplatin plus 5-fluorouracil versus transarterial chemoembolization/embolization for the treatment of advanced hepatocellular carcinoma with major portal vein tumor thrombosis[J]. Cardiovasc Intervent Radiol, 2020, 43(7): 996-1005. DOI: 10.1007/s00270-019-02406-3.
[26]	ZHENG K, WANG X, CAO G, et al. Hepatic arterial infusion chemotherapy with oxaliplatin and 5-fluorouracil for advanced gallbladder cancer[J]. Cardiovasc Intervent Radiol, 2021, 44(2): 271-280. DOI: 10.1007/s00270-020-02661-9.
[27]	ARAI Y, TAKEUCHI Y, INABA Y, et al. Percutaneous catheter placement for hepatic arterial infusion chemotherapy[J]. Tech Vasc Interv Radiol, 2007, 10(1): 30-37. DOI: 10.1053/j.tvir.2007.08.007.
[28]	GUYATT GH, OXMAN AD, VIST GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recom-mendations[J]. BMJ, 2008, 336: 924-926.
[29]	YAMAGAMI T, KATO T, ⅡDA S, et al. Efficacy of the left gastric artery as a route for catheterization of the right gastric artery[J]. AJR Am J Roentgenol, 2005, 184(1): 220-224. DOI: 10.2214/ajr.184.1.01840220.
[30]	HU J, CAO G, XU L, et al. Retrograde embolization technique of the right gastric artery during the implantation of port-catheter system for hepatic arterial infusion chemotherapy[J]. J Interv Med, 2021, 4(1): 27-31. DOI: 10.1016/j.jimed.2020.10.004.
[31]	WANG YJ, LAO IH, TZENG WS, et al. Hepatic artery infusion catheter implantation without embolization of the gastroduodenal artery in cases of retrograde blood flow[J]. J Vasc Interv Radiol, 2010, 21(8): 1297-1300. DOI: 10.1016/j.jvir.2010.04.016.
[32]	YAMAGAMI T, KATO T, HIROTA T, et al. A simplified method for continuous hepatic arterial port-catheter system placement not requiring catheter end-hole occlusion[J]. Acta Radiol, 2006, 47(8): 775-779. DOI: 10.1080/02841850600854910.
[33]	ZHAO X, SUN X, JING J, et al. Safety study of Folfox-HAIC in relieving bed restriction[J]. J Interv Med, 2021, 4(4): 203-207. DOI: 10.1016/j.jimed.2021.10.003.
[34]	KEY NS, KHORANA AA, KUDERER NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update[J]. J Clin Oncol, 2020, 38(5): 496-520. DOI: 10.1200/JCO.19.01461.
[35]	MURATA S, TAJIMA H, ABE Y, et al. Transcatheter management for multiple liver tumors after hepatic artery obstruction following reservoir placement[J]. Hepatogastroenterology, 2005, 52(63): 852-856.
[36]	YAMAGAMI T, KATO T, ⅡDA S, et al. Interventional radiologic treatment for hepatic arterial occlusion after repeated hepatic arterial infusion chemotherapy via implanted port-catheter system[J]. J Vasc Interv Radiol, 2004, 15(6): 633-639. DOI: 10.1097/01.rvi.0000127896.85305.ba.
[37]	KANG ZL, YANG RJ. Research of arterial port-catheter system in tumor interventional treatment[J]. Chin Clin Oncol, 2010, 15(10): 952-954. DOI: 10.3969/j.issn.1009-0460.2010.10.020. 康志龙, 杨仁杰. 动脉导管药盒系统在肿瘤介入治疗中的应用进展[J]. 临床肿瘤学杂志, 2010, 15(10): 952-954. DOI: 10.3969/j.issn.1009-0460.2010.10.020.