在ERAS理念下对比桡动脉入路与股动脉入路TACE的临床疗效

Comparison of Clinical Efficacy of TACE via Radial Artery Approach versus Femoral Artery Approach under the ERAS Concept

摘要: 背景：肿瘤患者外周血炎症指标与长期和短期预后密切相关。然而，不同干预方法对炎症指标的影响尚不清楚。目的：我们的目的是证明经桡动脉途径的经导管动脉化疗栓塞(TACE)具有较低的炎症反应，更能体现加速康复外科(ERAS)理念。材料与方法：自2023年1月至2024年12月，在重庆医科大学附属第二医院肝胆外科，对242例首次接受经动脉化疗栓塞(TACE)治疗的肝癌患者进行了回顾性分析。其中，103例患者接受经肝动脉化疗(TFA)治疗，139例患者接受经肝动脉化疗栓塞(TRA)治疗。对TFA组和TRA组患者的围手术期临床数据进行了分析和比较。主要关注点为全身炎症反应水平，其次为一般状况、舒适度、总住院时间和术后疼痛评分。结果：两组的基线数据无显著差异。经腹手术(TRA)组的术后中性粒细胞与淋巴细胞比值(NLR) (8.4 [95%置信区间5.0~12.0] VS 10.7 [95%置信区间5.4~18.9]；P = 0.02)和血小板与淋巴细胞比值(PLR) (145.1 [95%置信区间85.7~211.2] VS 181.1 [95%置信区间114.0~303.7]；P = 0.026)显著低于经腹主动脉手术(TFA)组。经腹手术组的术后淋巴细胞与单核细胞比值(LMR) (1.6 [95%置信区间1.2~2.5] VS 1.4 [95%置信区间1.0~2.2]；P = 0.011)高于经腹主动脉手术组。经腹手术组的术后疼痛评分低于经腹主动脉手术组(3 [95%置信区间3~4] VS 4 [95%置信区间3~5]；P = 0.005)，且差异具有统计学意义。结论：在减少术后全身炎症反应方面，经桡动脉介入途径相较于股动脉途径具有更多优势，且更能体现加速康复外科(ERAS)理念。

Abstract: Background: The indices of peripheral blood inflammation in tumor patients are closely related to the long-term and short-term prognosis. However, the effect of different intervention methods on inflammatory indices is not clear. Objectives: Our purpose is to prove that TACE trans radial artery approach has lower inflammation reaction and better reflects the ERAS concept. Material and Methods: From January 2023 to December 2024, 242 patients who were diagnosed with liver cancer and received TACE treatment for the first time were analyzed retrospectively in the Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Chongqing Medical University. Among them, 103 patients received treatment via femoral artery approach (TFA), and 139 patients received treatment via radial artery approach (TRA). The clinical data of TRA group and TFA group were analyzed and compared during the perioperative period. The main concern was the level of systemic inflammatory response, followed by the general condition, comfort, overall length of hospital stay and postoperative pain score. Results: There was no significant difference in baseline data between the two groups. Postoperative neutrophil-to-lymphocyte ratio (NLR) (8.4 [95%CI 5.0~12.0] VS 10.7 [95%CI 5.4~18.9]; P = 0.02) and platelet-to-lymphocyte ratio (PLR) (145.1 [95%CI 85.7~211.2] VS 181.1 [95%CI 114.0~303.7]; P = 0.026) in TRA group were significantly lower than those in TFA group. Postoperative lymphocyte-to-monocyte ratio (LMR) (1.6 [95%CI 1.2~2.5] VS 1.4 [95%CI 1.0~2.2]; P = 0.011) in TRA group was higher than that in TFA group. Postoperative pain score was lower in TRA group than in TFA group (3 [95%CI 3~4] VS 4 [95%CI 3~5]; P = 0.005), and the difference was statistically significant. Conclusions: Interventional pathway via radial artery has more advantages than the femoral artery in reducing postoperative systemic inflammatory reaction and better reflects the ERAS concept.