恶性肿瘤经动脉介入治疗致脊髓损伤的临床研究

目的:探讨恶性肿瘤经动脉介入治疗致脊髓损伤的发生率、影像及临床表现、处理原则及预防措施。方法:284例肺恶性肿瘤患者行420例次选择性支气管动脉介入治疗,63例肾癌患者行96例次经肾动脉介入治疗(部分例次经腰动脉介入治疗),肺恶性肿瘤和肾癌患者的介入治疗之和占同期恶性肿瘤经动脉介入治疗的2.0%。恶性肿瘤经动脉介入治疗后出现8例次脊髓损伤,对其临床资料进行回顾性分析。结果:肺恶性肿瘤经支气管动脉介入治疗,肾癌经肾动脉、腰动脉介入治疗,脊髓损伤发生率分别为1.2%、2.1%,1例次具有右膈动脉侧支供血的肝癌对右膈动脉行TACE术时出现脊髓损伤。同期的其他介入治疗(如腹腔动脉、肝动脉、脾动脉、肠系膜上动脉等)无脊髓损伤。血管造影仅1例次(1/8)显示脊髓根动脉及脊髓前动脉,造影即刻至数小时出现脊髓损伤症状。使用大剂量激素、血管扩张剂、脱水剂、神经营养剂等治疗,尽早进行康复训练,脊髓功能在0.5～3.5个月左右基本恢复。结论:恶性肿瘤经动脉介入治疗可导致脊髓损伤发生,血管造影脊髓根动脉及脊髓前动脉显示率低,术前及术中应以多种预防措施减少其发生率,术后积极治疗、尽早进行康复训练,脊髓功能可基本恢复。

The clinical research of spinal cord injury caused by transarterial interventional therapy for malignant tumor

Objective:To explore the incidence,medical imaging,clinical appearance,treatment and preventive measures of spinal cord injury caused by transarterial interventional therapy for malignant tumor.Methods:284 cases of pulmonary malignant tumor with 420 times transbronchial artery interventional therapy,63 cases of renal carcinoma with 96 times transrenal artery interventional therapy(partly translumbar artery interventional therapy),were analyzed retrospectively with spinal cord injury caused by transarterial interventional therapy.The number of above two interventional therapies were about 2% of the total interventional therapy for Malignant tumor.There were 8 cases of spinal cord injury caused by transarterial interventional therapy for Malignant tumor.Results:The incidences of spinal cord injury caused by transbronchial artery interventional therapy and transrenal artery interventional therapy(partly translumbar artery interventional therapy),were respectively 1.2%,2.1%.There was a case of spinal cord injury caused by transarterial chemoembolization for treating hepatocellular carcinoma with the collateral feeding arteries from the right inferior phrenic artery.There was no case of spinal cord injury caused by interventional therapy via the celiac artery,hepatic artery,splenic artery and superior mesenteric artery for treating carcinoma.There was only one case(1/8) that the radicular arteries and anterior spinal artery were shown in angiography.The symptoms of spinal cord injury appeared instantly or several hours after angiography.By use of large doses of hormones,vasodilators,dehydrating agents and rehabilitation therapy in the treatment of spinal cord injury,all the spinal cord function restored to Frankel E from 0.5 to 3.5 hours.Conclusion:Via the transarterial interventional therapy for malignant tumor could cause spinal cord injury,and the display rate of radicular arteries and anterior spinal artery is low.The preoperative and perioperative prevention measures should be taken to reduce its incidence.With the active drug treatment and rehabilitation therapy,the spinal cord function can return almost to normal state.