肝癌肝动脉栓塞化疗术并发碘油肺栓塞的临床观察

探讨肝癌肝动脉栓塞化疗术并发碘油肺栓塞的发病机制、临床表现、治疗方法及预防措施。分析肝癌行TACE术后发生碘油肺栓塞7例患者的术前肝脏CT、术中DSA检查、术中所用的碘油量及化疗药物剂量、术中术后的临床表现、辅助检查及临床治疗情况。患者出现不同程度的咳嗽、咯血、呼吸困难和低氧血症,胸片可见片状密度增高影。给予吸氧、扩张支气管、必要时呼吸机辅助呼吸及其他支持治疗后好转。随访观察20d～2个月,复查胸片正常。7例病例病灶直径约>10cm,存在肝动脉-肝静脉瘘的5例,碘油用量>20mL的5例。初步研究结果提示,碘油肺栓塞常发生在巨块型肝癌,且多存在肝动脉-肝静脉瘘,碘油用量多>20mL,术中正确处理可减少此类并发症的发生。

Pulmonary lipiodol embolism in transcatheter arterial chemo embolization for hepatocellular carcinoma

The objective of this study was to investigate the mechanism,clinical characteristics,treatment and prevention of pulmonary embolism in transcatheter arterial chemoembolization(TACE).Seven cases of pulmonary lipiodol embolism(PLE)were anelysed during transcatheter arterial chemoembolization for hepatocellular carcinoma were analized.PLE was diagnosed by the liver computered tomography(CT)scan,digital subtraction angiography(DSA)examination,diagnostic examinations,and clinical signs.The dosage of lipiodol and chemotherapeutic drugs,treatment and the above examinations were evaluated.Cough,haemoptysis,dyspnea,hypoxemia and lamellar hyperdense mass appeared in these patients after TACE and improved after the treatment with oxygen inhale,bronchus dilator,breathing machine when necessary,and other supportive nveans.After the following-up for 20-day to 2-month,X-ray turned normal.The focus was about 10 cm in diameter in all the 7 patients.There were 5 cases with patients with hepatic artery to hepatic vein fistulous and 5 cases with over-dose of lipiodol of 20 mL.Huge hepatocellular carcinoma,hepatic artery to hepatic vein fistulous,and an overdose of lipidol are risk factors of PLE,which can be reduced by exactitude and precise operation during TACE.