肝脏肿瘤介入治疗并发症体会

目的:对肝脏肿瘤介入治疗的并发症进行分析,并就其出现的原因、处理措施及如何预防做进一步探讨。方法:对经CT、MR、USG及手术病理证实的75例肝脏良、恶性肿瘤患者,其中,原发性肝癌65例;原发性肝癌术后复发3例;肝转移瘤4例;肝血管瘤3例。共做了135次介入治疗,每人1~5次。全部病例采用Seldinger穿刺技术,一侧股动脉穿刺插管(通常为右侧股动脉),肝动脉内栓塞和(或)灌注化疗药物的方法。结果:本组肝脏肿瘤介入治疗术中及术后,有4人次出现了肝动脉痉挛闭塞,局部剧烈疼痛,消化道出血,造影剂过敏等较为严重的并发症。结论:肝脏肿瘤介入治疗出现严重并发症的原因有短时间内灌注化疗药物用量过大、过浓;靶动脉异常分支与其它血管形成吻合;栓塞颗粒太小;造影剂选择不恰当。介入术者应尽可能选择适当置管的位置,应用适量的化疗药物稀释后缓慢灌注,尽可能选择非离子型造影剂。

Complications in interventional therapy for liver tumor

Objective: To analyze complications in liver tumor interventional therapy, their cause, and prevention. Methods: In 75 patients with benign or malignant liver tumor diagnosed by CT, MR, USG or pathology (Primary liver cancer 65 cases, relapse after operation 3 cases, metastasis 4 cases, hemongioma 3 cases ). Each patient rceceived 1~5 times of treatment, with total of 135times. All were applied by Seldinger puncture technique, puncturing in one side femoral and intubating (normally right temoral), then embolicating the hepatic artery or/and perfusing. Results: During and after treatment, in 4 patients occured severe complications: hepatic artery spasm and ocdusion, regional agony, alimentary tract bleeding,contrast-medium irritability. Conclusion: The cause of complications: The chemotherapeutic drugused is too excessive and strong. In short time, the target artery has abnormal offsets and forms anastomose with other blood vessel; Embolus are too small; The choice of contrast-medium isn/t fit. The operator should select the proper position to place catherter, and slowly perfuse appropriate dose of chemotherapy drug after dilution and select nonionic contrast-medium as possible.