支气管动脉化疗栓塞术导致脊髓损伤的原因与对策

Causes and strategy of spinal cord injury in bronchial arteries interventional for the lung diseases

目的探讨肺部病变支气管动脉介入治疗致脊髓损伤的因素及对策。方法常规组采用支气管动脉灌注化疗或加栓塞术治疗肺癌,采用支气管动脉明胶海绵颗粒栓塞术治疗大咯血;试验组术前加行利多卡因脊髓功能诱发试验。结果常规组583例中,肺癌373例,发生脊髓损伤11例;大咯血210例(其中支气管扩张150例、肺结核44例、肺血管畸形12例和肺隔离症4例),未发生脊髓损伤,两者相比差异显著(P<0.05)。试验组403例(肺癌318例和大咯血85例)中,脊髓功能诱发试验阳性58例,经微导管超选择治疗无一例发生脊髓损伤。结论支气管动脉介入治疗中,肺癌较易并发脊髓损伤,可能主要与高浓度的毒性药物损伤有关,而颗粒性栓塞影响较小。术前应用利多卡因脊髓功能诱发试验判断支气管动脉是否与脊髓根动脉共干,能有效避免脊髓动脉损伤。

Objective To approach the causes and the strategies of spinal cord injury induced by bronchial arteries inter ventional technology for lung diseases. Methods In the routine group, patients with lung carcinoma received the perlusion and embolization of the branchial artery, and the patients with haemoptysis received the embolization with the granula of gelatin sponge. In the experiment group, the patient received the spinal cord ability inducing test before the treatment. Results In the routine group （583 patients）, 373 patients of lung carcinoma received the therapy, spinal cord injury occurred in 11 cases, but none in patients with other diseases after the treatment forhaemoptysis （150 cases of bronchiectasis, 44 of tuberculosis, 12 of lung vascular malformation, and 4 cases of pulmonary sequestration, P〈0.05）. In the experiment group （403 patients, 318 cases of bronchogenic carcinoma, 85 cases of haemoptysis）, 58 cases had the masculine result of the spinal cord ability inducing test, and no spinal cord injury occurred after the treatment using the micro-catheter with ul tra-selection. Conclusion Patients of lung carcinoma have relatively high incidence rate of spinal cord injury after bronchial arteries interventional therapy, relating to the high concentration venomous drugs as well as the embolization of non-periph cry vessles. The spinal cord ability inducing test can be used to judge whether the bronchial artery related with the spinal cord radicular arteries before the bronchial interventional therapy, so as to avoid the occurrence of spinal cord iniury.