原发性肝癌动脉化疗栓塞术少见严重并发症分析

Analysis of rare and severe complications of transcatheter arterial chemoembolization for primary hepatic carcinoma

目的：对原发性肝癌（primary hepatic carcinoma ，PHC）动脉化疗栓塞术（transcatheter arterial chemoemboli-zation ，TACE）术后发生的少见严重并发症发生原因做相关分析。方法分析2010年1月～2013年10月间351例PHC患者行TACE治疗患者资料，对发生少见严重并发症的患者影像及临床相关资料做相应分析，以期得出不同严重并发症的发生原因及预防措施。结果少见严重并发症包括肝破裂出血3例，1例经保守治疗后好转，2例死亡；肝脓肿2例，1例经抗感染及脓肿穿刺引流治愈，1例发生感染性休克而死亡；1例食管胃底静脉曲张破裂大出血，经内科止血处理好转；1例并发急性胆囊炎经对症处理后好转；余3例分别死于碘油脑栓塞（cerebral lipiodol embolism ，CLE）、肺栓塞和股动脉延迟出血。结论原发性肝癌T ACE治疗严重并发症临床少见，一旦发生可能危及患者生命，因此严格遵循PHC诊疗规范，把握适应证，合理控制化疗药物剂量技术及栓塞程度。

Objective To analyze the factors that result in rare and severe complications after transcatheter arterial che-moembolization （TACE） for primary hepatic carcinoma （PHC） ,thus to reduce the occurrence rate of these kind of compli-cations .Methods A retrospective study of a consecutive group of 351 patients with PHC who underwent TACE proce-dures was performed from January 2010 to October 2013 .Imaging and clinical records of rare and severe complications were reviewed to find possible causes and underlying factors in order to find the preventive methods which can reduce the occurrence rate .Results 3 patients had spontaneous hepatic rupture after TACE procedures ,one was cured after conser-vative management ,two was died of hemorrhagic shock .Two patients got liver abscess ,one was cured after adequate drainage and anti-infective therapy ,another was died of septic shock .One patient experienced esophageal and gastric vari-ces bleeding and recovered after 11 days symptomatic treatment .One patients experienced acute cholecystitis and was cured after symptomatic treatment .Three patients were died of cerebral lipiodol embolism ,pulmonary oil embolism and delay femoral artery bleeding respectively .Conclusion Severe complications of TACE for PHC are rare in clinic ,but can result in serious injury even death to patients .Thus ,strictly following the guideline of diagnosis and treatment of PHC , cautious selection the indications ,reasonable control the dose of chemotherapeutics and the embolic degree ,and focus on the dispose of perioperative period are important measures to reduce occurrence rate of these kinds of complications .