Hepatic artery intubation and perfusion
Continuous infusion of anticancer drugs for hepatic artery cannula is suitable for the treatment of liver cancer patients who cannot be removed or undergoing palliative resection. Since the blood supply of liver cancer is mainly from arteries, this method can directly exert drugs on tumor tissues and increase local drug concentration. Reduce systemic reactions, achieve the purpose of treating tumors, alleviating symptoms and prolonging life.Treating diseases: liver cancer Indication
Hepatic artery intubation and perfusion are applicable to:
1. Unresectable primary or secondary liver cancer, hepatic artery cannulation is feasible at the same time as hepatic artery ligation.
2, liver cancer palliative resection of the liver section with residual tumors, portal vein branch with cancer, can be portal vein catheterization chemotherapy.
3, postoperative prophylactic chemotherapy. Most of the primary liver cancers are combined with small satellite lesions and small tumor thrombus in the portal vein. Surgical compression of the tumor is one of the important causes of tumor spread. Therefore, although radical resection is necessary, it is necessary to preventively. Chemotherapy to prevent recurrence.
4, normal liver function, no obvious cirrhosis, no jaundice, ascites, heart, lung, kidney and other important organs function properly.Contraindications
1, the middle and late stage liver cancer portal vein tumor thrombus, lymph node metastasis.
2. The primary lesion of secondary liver cancer was not removed.
3, hepatic artery variability, intubation is difficult; we found in operation that a small number of patients with vagus hepatic artery is very thick, and the normal hepatic artery is very thin, the catheter is difficult to insert, can only give up the intubation.
4, severe cirrhosis with portal hypertension, patients can not tolerate the operator.
5, severe cirrhosis, although liver cancer resection, but it is estimated that postoperative patients with difficult liver function recovery, difficult to tolerate chemotherapy.Preoperative preparation
Prepare routinely before surgery.Surgical procedure
1, the choice of intubation site
(1) When liver cancer can not be removed, the hepatic artery can be ligated at the same time as the distal end of the ligation artery, mainly for the left and right arteries of the liver.
(2) After hepatectomy, the hepatic artery blood supply should be preserved. The right gastric artery or the gastroduodenal artery can be intubated. In particular, the success rate of intubation is high.
(3) The portal vein can be selected by the umbilical vein or the right venous approach of the gastric retina.
2, intubation method
(1) When the left and right arteries of the liver are intubated, the method described in the interstitial hepatic artery occlusion is the same. The catheter is taken out and fixed outside the abdominal wall.
(2) Intubation through the gastroduodenal artery: 1 The hepatic artery, the left and right hepatic artery, the common hepatic artery and the gastroduodenal artery were isolated, and were sutured by silk thread, and the stomach was double-ligated. The distal end of the intestinal artery; 2 a small oblique incision is made at the proximal end of the gastroduodenal artery ligation line, and a catheter filled with heparin is inserted into the gastroduodenal artery, and enters the left or right hepatic artery along the proper hepatic artery. Inside, intubate the artery with your finger to understand the direction of the catheter and the end position; 3 double ligation of the gastroduodenal artery, the other end of the catheter is externally sutured and fixed by the abdominal wall; 4 ligation of the right gastric artery, if necessary, remove the gallbladder, to prevent Chemotherapy and embolic agents reflux the stomach, duodenum and gallbladder.
(3) Determine the position of the catheter and the distribution of the drug perfusion zone: After the catheter is successfully inserted, inject 2 ml of methylene blue into the catheter before the catheter is fixed, and observe the liver staining. If the liver is only partially stained, the catheter is too deep. Out of the box, the ideal location is that the tumor is completely stained without exceeding half of the liver. After the operation, the contrast agent or iodized oil can be injected through the catheter to understand the distribution of the drug in the liver, and the effect of postoperative chemoembolization can be judged accordingly.