肝癌TACE术并发脑碘油栓塞二例并文献复习

Cerebral Lipiodol embolism occurred after transcatheter arterial chemoembolization for hepatocellular carcinoma:report of two cases with literature review

目的提高对肝癌TACE术并发脑碘油栓塞的认识。方法回顾分析2例肝癌TACE术后并发脑碘油栓塞的临床及影像学资料,结合国内外散在个案报道,探讨其可能的病理机制、危险因素、及影像学特征。结果肝内、心内及肺内异常分流是脑碘油栓塞的形成机制。肿瘤动脉-肝静脉分流、肿瘤紧邻或侵犯膈肌、膈动脉参与肿瘤供血、肿瘤血供丰富、术中大量使用碘油是危险因素。脑碘油栓塞CT及MRI有特征性表现。结论肝癌TACE术并发脑碘油栓塞少见,了解其发病机制、危险因素及影像学特征,可预防和及时发现处理脑碘油栓塞。

Objective To further understand the complication of cerebral Lipiodol embolism （CLE） caused by transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （HCC） Methods The clinical and imaging data of two patients of CLE which occurred after TACE for HCC were retrospectively analyzed. Consulting the relevant case reports widely scattered in medical literature both at home and abroad, the pathologic mechanism and risk factors as well as the imaging features of CLE were discussed. Results The abnormal right-to-left shunt in the liver, heart and the lung was the underlying mechanism inducing CLE after TACE. The risk factors included： formation of hepatic arterio-venous shunt, close contact of tumor to the diaphragm, tumor invasion of diaphragm, phrenic artery participating in the blood supply of tumor, tumor with abundant blood flow, use of large quantity of Lipiodot in the procedure, etc. On CT and MRI, CLE had some characteristic manifestations. Conclusion CLE is an extremely rare complication caused by TACE for HCC. Full familiar with its risk factors and imaging features is very helpful in preventing and treating CLE.