肝癌动脉栓塞治疗中出现的肝静脉“碘油轨道征”与术后猝死的相关性

Correlation between postoperative sudden death and hepatic vein “lipiodol tram-track sign” occurring in the performance of arterial embolization for liver cancer

目的通过观察分析肝癌患者动脉栓塞治疗过程中出现的肝静脉"碘油轨道征",判断其与术后发生急性猝死有无直接关联。方法回顾北京世纪坛医院2010年1月—2013年10月接受动脉碘油栓塞介入治疗的肝癌患者,统计术后48 h内猝死病例术中是否存在肝静脉"碘油轨道征"。结果统计期间共计完成肝癌肝动脉栓塞治疗5 372例次,其中术后48 h内有7例患者猝死,占总病例0.095%,术中存在肝静脉"碘油轨道征"5例,占死亡病例71.43%。另48 h内存活的5 365例患者中发现4例"碘油轨道征",占存活患者的0.07%,两组差异有统计学意义(P=0.00)。结论肝癌动脉栓塞治疗术中出现肝静脉"碘油轨道征",可以判断患者术后短期内发生猝死概率大,应缩短猝死前疾病进展判断时间和提高抢救治疗力度,制订正确预防预警、治疗方案,尽可能提高延长患者生存时间。

Objective To discuss the correlation between postoperative sudden death and hepatic vein ＂lipiodol tram- track sign＂ that occurs during the performance of arterial embolization for liver cancer.Methods During the period from Jan. 2010 to Oct. 2013, a total of 5 372 times of arterial embolization for liver cancer were carried out at Beijing Shijitan Hospital. The occurrence of sudden death within 48 hours after the treatment and the incidence of hepatic vein ＂lipiodol tram- track sign＂ were recorded, and the correlation between postoperative sudden death and hepatic vein ＂lipiodol tram- track sign＂ was evaluated.Results Sudden death within 48 hours after the treatment occurred in 7 patients, accounting for 0.095% of the total patients. During the performance of arterial embolization, hepatic vein ＂lipiodol tram- track sign＂ was detected in 5 cases. Besides, among 5 365 patients who were alive within 48 hours after the embolization therapy, hepatic vein ＂lipiodol tram- track sign＂ was found in 4 cases, accounting for 0.07% of the alive patients. The difference between the two groups was statistically significant（P = 0.00）. Conclusion The possibility of postoperative sudden death occurring within short period after arterial embolization for liver cancer is higher in the patients who shows hepatic vein ＂lipiodol tram- track sign＂ during the performance of arterial embolization. The occurrence of ＂lipiodol tram- track sign＂ should be regarded as a warning to physician that proper and urgent prevention measures as well as therapeutic scheme needs to be formulated in order to prolong the patient＇s survival time.