Graves病介入治疗并发异位脑栓塞的原因及防治

目的探讨Graves病甲状腺动脉栓塞治疗引起脑栓塞的原因及防治方法。方法对2例Graves病甲状腺动脉栓塞术发生异位脑栓塞的原因进行分析,研究有效预防异位脑栓塞的方法。结果异位脑栓塞是Graves病栓塞治疗严重而危险的并发症,有其发生的解剖基础。发生异位脑栓塞的原因主要是操作性的,有注射反流、退管拖带、管腔残留、器械沾染等误栓。制定了一套严格的预防异位脑栓塞的措施,包括自塑形导管的使用、熟悉甲状腺介入的血管解剖、严格区分与栓子有关的器械、抗血管痉挛、避免操作性误栓;早期诊治脑栓塞等。结论明确Graves病介入栓塞并发脑治疗的严重性和解剖基础,严格操作规程,异位脑栓塞是可以预防的。

The causes and prophylaxis of complicating cerebral embolism in interventional therapy of Graves' disease

Objective To investigate the causes and prophylaxis of cerebral embolism in thyroid arterial embolization of hyperthyroidism induced by Graves' disease. Methods The causes of dystopia cerebral embolism were analyzed in two cases of thyroid arterial embolizations. Results The main causes of dystopia cerebral embolism were manipulating mistakes, including injected backstreaming, drawing-catheter towing, intraductal residual embolia, appliance contamination, etc. A set of operation regulations was established accordingly, following which no dystopia cerebral embolism happened thereafter among 51 cases of thyroid arterial embolizations. Conclusion Complicating dystopia cerebral embolism during interventional embolization in the treatment of Graves' disease can be avoided if operating strictly conform to the interventinal regulations.