肝动脉栓塞治疗肝癌致碘化油脑栓塞的原因及防治:2例报道并文献复习

Cerebral lipiodol embolism after transarterial chemoembolization in the treatment of primary liver cancer:report of two cases with literature review

目的探讨和分析肝动脉栓塞化疗(TACE)治疗原发性肝癌过程中发生碘化油脑栓塞(CLE)的机制,并探寻相应的预防和治疗措施。方法收集广东省人民医院介入科2例原发肝癌患者TACE术后出现CLE的临床资料,并结合国内外相关文献报道34例,探讨TACE在治疗原发性肝癌过程中发生碘化油脑栓塞的发生机制、预防及治疗措施。结果 2例患者均非首次TACE治疗过程中出现CLE,2例患者均为膈下巨块型肝癌。收集国内外病例36例,其中接受TACE 4次及以上10例(27.8%);碘化油用量≥20 ml 19例(52.8%);巨块肿瘤(直径≥10 cm)15例(41.7%)。结论碘化油脑栓塞是肝癌患者接受TACE治疗时罕见而又严重的并发症,TACE治疗次数、碘化油用量、巨块型肿瘤、膈下动脉供血可能与其发生有直接关系。CLE应以预防为主,一旦发生应积极抢救治疗,可获得较好恢复。

Objective To analyze the cause of cerebral lipiodol embolism （CLE） after transarterial chemoembolization （TACE） in patient with primary liver cancer, and investigate the preventive strategies of CLE. Methods We present 2 cases of cerebral lipiodiol embolism that occurred after TACE, together with 34 cases from literatures, to analyze the cause and mechanism of CLE after TACE. Results Totally 36 cases were analyzed, in which ten of them occurred with CLE more than forth times of TACE （27.8%）, 19 （52.8%） infused more than 20 ml lipiodol, and 15 （41.7%） were with huge tumor. Conclusion Cerebral lipiodol embolism is a rare and severe complication of TACE. The most probable causing factors of cerebral lipiodol embolism are the intervention therapy times, the dose of lipiodol, the size of tumor and the abnormal tumor feeding arteries. It is vitally important to prevent cerebral lipiodol embolism during TACE. Once cerebral embolism occurred, the positive emergency treatment must be immediately performed.