肝癌肝动脉化疗栓塞术后并发碘化油肺栓塞的临床分析

Clinical discussion of pulmonary iodized oil embolism in the patients with hepatic carcinoma after transcatheter arterial Chemoembolization

目的：探讨肝动脉化疗栓塞术后并发碘化油肺栓塞的临床表现、治疗方法及预防措施,以提高对此并发症的认识和处理。方法：收集2000年9月～2008年3月肝癌TACE术后并发碘化油肺栓塞8例,分析患者的术前肝脏CT及胸片、术中造影检查、碘化油用量及化疗药物剂量、临床表现、治疗情况及术后随访。结果：8例碘化油肺栓塞患者均出现不同程度的咳嗽、咳血、渐进性呼吸困难、胸片和/或CT可见片状高密度影。给予吸氧、扩张支气管、减轻炎症反应等治疗后好转7例,死亡1例。7例患者3～15天症状消失,其中有2例患者给予呼吸机辅助呼吸。随访观察20～60天,复查胸片正常。病灶直径≥10cm的6例,存在肝动脉-肝静脉瘘的6例,碘化油用量≥20ml的7例。结论：碘化油肺栓塞常发生在巨块型肝癌和/或存在肝动静脉瘘的患者,碘化油用量多超过20ml,术中正确仔细的处理可减少此类并发症的发生。

Objective：To discuss clinical manifestations, treatment and preventive methods of pulmonary iodized oil enbolism in the patients with hepatic carcinoma who underwent TACE. Methods：To retrospectively analyse medical records of 8 pulmonary iodized oil embolism in the patients with hepatic carcinoma after transcatheter arterial chemoembohzation, such as CT finding, DSA finding in operation, doses of both iodized oil and anticancer drug, ehnical manifestations, therapy and follow-up examination. Results：8 patients of pulmonary iodized oil embolism had the symptoms of cough, hemoptysis, dyspnea hypoxemia and abnormal chest radiographs. 7 patients improved and one patient died. Their clinical manifestations improved throughout giving oxygen, bronchi dilation, ventilation assistance by respirator in time and supporting treatment, then chest radiographic abnormalities completely cleared 20 - 60 days after TACE. Diameter of tumor exceeded 10 cm in 6 patients. 6 patients had hepatic arteriovenvous shunting. More than 20 ml iodized oil was used in 7 patients. Conclusion：Pulmonary iodized oil embolism occurrs easily in patients who have huge hepatic carcinoma or/and hepatic arteriovenvous shunting, and more of them used more than 20 ml iodized oil. We can reduce this complication ff we are more careful and serious in operation.