原发性肝癌经导管肝动脉化疗栓塞术后肺栓塞4例临床分析  

ANALYSIS THE REASONS OF PULMONARY EMBOLISM AFTER TRANSCATHERTER ARTERIAL CHEMOEMBOLIZATION IN HEPATOCELLULAR CARCINOMA

作　　者：尹磊[1] 潘泽亚[1] 吴伯文[1] 刘辉[1] 周伟平[1] 

机构地区：[1]上海东方肝胆外科医院,上海200438

出　　处：《肝胆外科杂志》2008年第3期174-177,共4页Journal of Hepatobiliary Surgery

摘　　要：目的分析原发性肝癌经导管肝动脉化疗栓塞(TACE)术后并发肺栓塞的临床特点,探讨发生机制、早期诊断和治疗方法。方法2000年1月至2007年12月,在我院接受TACE的原发性肝癌患者31869人次,其中术后出现肺栓塞患者4例。回顾性分析该4例患者的临床特点及发病机制、诊断、治疗方式。结果TACE术后并发肺栓塞例数占同期我院TA-CE例数的0.02%;出现肺栓塞时间为术后0.5h～5d,患者表现为呼吸困难、紫绀、心悸、胸痛、黄疸、血尿及血PO2、SatO2下降等肺栓塞症状;本组死亡2例,死亡率50%。结论肺栓塞是原发性肝癌患者TACE术后的严重并发症,是碘油阻塞为主的多种栓塞因素共同作用的结果。本病起病急骤,死亡率高。肺动脉造影及D-Dimer是早期明确诊断的重要方法。Objective To discuss the clinical characteristics, pathogenic mechanism, early diagnosis and treatment for pulmonary embolism after transcatheter arterial chemoembolization（TACE） in hepatocellular carcinoma. Methods From January 2000 to December 2007,4 cases suffered pulmonary embolism after TACE in the total of 31869 hepatocellular carcinoma patients. The clinical characteristics, pathogenic mechanism, early diagnosis and treatment of these 4 cases were retrospectively analyzed. Results The incidence of pulmonary embolism was 0. 02% after TACE. Pulmonary embolism was found during 0. 5 hour to 5 days after TACE. They show characteristics syndrom of pulmonary embolism, such as difficult breathe, cyanosis, cardiopalmus, thoracodynia, jaundice, hematuria and degression of oxygen partial pressure and saturation of blood oxygen. 2 patients died, and the mortality was 50%. Conclusion：Pulmonary embolism is one of the serious complicants after TACE in hepatocellular carcinoma and is caused by multiple factors in which iodized oil occlusion is the chief factor. It has a flash onset and a high mortality. Pulmonary angiography and D-Dimer play an important part in the early diagnosis.

关 键 词：原发性肝癌 经导管肝动脉化疗栓塞 并发症 肺栓塞 

分 类 号：R735.7[医药卫生—肿瘤]