支气管动脉化疗、栓塞严重并发症易发因素及其预防的回顾性研究

目的研究支气管动脉化疗、栓塞并发症的易发因素及其预防措施。方法678例患者,肺癌灌注加栓塞化疗共584例,大咯血支气管动脉栓塞术94例,行选择性支气管动脉插管造影,明确供血血管,在支气管动脉干或支气管动脉分支内超选择插管下灌注化疗或栓塞。化疗药物:5-FU、丝裂霉素、顺铂、阿霉素。栓塞物质:无水酒精、明胶海绵、丝线。结果单纯化疗组脊髓损伤0.3%。化疗加酒精栓塞组,肺动脉栓塞及脊髓损伤均为10%,肋间动脉缺血30%。明胶海绵加丝线栓塞组,脊髓损伤及肺动脉栓塞1.1%,异位栓塞及肋间动脉缺血均为3.2%。结论无水酒精支气管动脉栓塞应慎用,明胶海绵、丝线是相对安全的栓塞物质,同轴微导管超选择支气管动脉插管技术值得推广。

Risk Factors and Prevention of Serious Complications in Bronchial Arterial Chemotherapy and Embolization

Objective]To evaluate of complications related factors and preventive measure of bronchial arterial chemotherapy and embolization.Methods]Bronchial arterial chemotherapy and embolization were performed in 678 cases,584 of them with lung cancer and others with hemoptysis.Bronchial artery angiograms were taken to confirm the blood supply of lesions,chemotherapy or embolization was then performed in bronchial artery or its branches .Chemotherapy medication:5-Fu,MMC,DDP,ADM. Embolic agents used were absolute alcohol, gelfoam particles,silk thread.Results]Complications in single chemotherapy group were transverse myelitis(0.3%),in chemotherapy with absolute alcohol embolization group were both lung infarction and transverse myelitis(10%),intercostal artery ischemia(30%).In gelfoam particle and silk thread embolism group:both lung infarct and transverse myelitis were 1.1%, both the reflux of embolic material into the aorta without adverse sequelae and intercostal artery ischemia were 3.2%.Conclusion]Transcatheter bronchial arterial embolization with absolute alcohol should be performed carefully.Gelfoam particles and silk thread are relatively safe embolic agents.It is of value to use superselective catheterization to avoid potential ischemic complications.