Hemorrhage of Gastroepiploic Artery Induced by Hepatic Artery Infusion Chemotherapy (HAIC) Catheter-Port System Implantation: Five Cases Report

肝動脈化療導管暨注射基座系統植入術導致胃大網膜動脈出血：五病例報告

方瑞隆(Jui-Lung Fang) ； 曾文盛(Wen-Sheng Tzeng) ； 王彥人(Yen-Jen Wang) ； 吳仁宏(Reng-Hong Wu) ； 張世欽(Shih-Chin Chang)

《中華放射線醫學雜誌》 34卷3期 (2009/09) Pp. 213-219

摘要

肝動脈化療經常是用在無法開刀的原發性或轉移性惡性肝腫瘤的治療方法，而在肝動脈化療導管暨注射基座系統植入時經常將導線置於胃大網膜動脈來做為支撐導管置入的路徑，所以在肝動脈化療導管暨注射基座系統植入過程中胃大網膜動脈可能會受到損害而有可能導致腹內之出血。若能早期發現出血，並適當止血就能避免更大的併發症產生。在此報告五例因肝動脈化療導管暨注射基座系統植入術造成胃大網膜動脈出血個案，包含三例於術中當場發現胃大網膜動脈明顯顯影劑外漏現象，一例於術後數小時發現腹內大量出血，以及一例於術後兩個月後可能因右腳靜脈血栓使用抗凝血藥物(Coumadin)而導致的遲發性出血。在經過血管攝影檢查於胃大網膜動脈適當血管栓塞止血後均能達成有效止血。

並列摘要

Hepatic artery infusion chemotherapy (HAIC) is used primarily in patients with inoperable primary or metastatic hepatic tumors. During HAIC system implantation, the guide wire used to support the insertion of the catheter can damage the gastroepiploic artery resulting in intraperitoneal bleeding when percutaneous catheter placement and tip fixation method was used. Five cases complicated by gastroepiploic arterial hemorrhage are reported. Three were found to have active contrast extravasation during implantation. One had massive intraperitoneal hemorrhage several hours after implantation, and another had late-onset hemorrhage two months later. All hemorrhages were successfully controlled by transarterial embolization (TAE) from gastroepiploic artery.