经导管肝动脉化疗栓塞术的严重并发症

Severe complications associated with transcatheter hepatic arterial chemoembolization

经导管肝动脉化疗栓塞术(THACE)目前已广泛用于中晚期原发性肝癌和肝转移瘤的治疗。THACE的严重并发症虽不常见(0%～5%),但其预后一般较差、病死率高。因此,充分了解适应证的选择、化疗栓塞剂的应用和导丝/导管的操作技术等因素与THACE的严重并发症的关系,对减少这些严重并发证的发生是非常重要的。根据严重并发症累及的解剖部位将其分为下列6类:①肝脏并发症,包括急性肝功能衰竭、肝梗(坏)死、肝脓肿和肝破裂。②肝脏血管并发症,包括肝动脉内膜损伤剥离、肝动脉狭窄/闭塞、肝动脉穿破/假性动脉瘤和多发性肝内动脉瘤。③胆系并发症,包括胆囊炎/胆囊坏死、胆管坏死/胆汁瘤。④肝胆以外脏器的并发证,包括脑、脊髓、肺、脾脏、胃十二指肠和胰腺的异位栓塞或梗死。⑤上消化道出血。⑥其他的严重并发症。对这些严重并发症的发生率、发生原因、高危因素、临床和影像学表现等亦作详细讨论,以便及早作出正确诊断及治疗。

Transcatheter hepatic arterial chemoembolization （THACE）has been widely used in the treatment of advanced primary hepatic carcinoma （PHC）and metastatic hepatic carcinoma （MHC）. Although the incidence of severe complications associated with THACE is unusual （0% - 5% ）, its prognosis is generally worse and mortality is higher than that of postembolization syndrome.Therefore, to minimize the risk associated with THACE has to be achieved through the understanding of these severe complications related to the selection of indication,the use of chemoembolic agents and manipulation of a eathether or guide wire, etc. In this paper, according to the involved anatomic organs, these severe complications are divided into six categories as follows ： （ 1 ）complications of the liver, including acute hepatic failure, liver infarction （necrosis）, liver abcess and liver （or tumor）ruptrure; （2）complications of the celiac artery and its branches, included of iatrogenic dissection, stricture or occlusion, perforation or pseudoaneurysm and multiple intrahepatic aneurysms; （3）complications of intrahepatic biliary system,included of cholecystitis and gallbladder infarction,bile duct necrosis and intrahepatic biloma formation; （4）complications of extrahepatic structures, included of nontarget embolism or infarction of the brain, spinal cord, lung, spleen, gastroduodenum and pancreas; （5）bleeding of upper digestive tract; （6）the orthers. And the incidence, pathogenesis, predisposing factors, clinical and imaging manifestations of these complications are also discussed in detail, it may be of great advantage to its correct diagnosis promptly and appropriate management.