[1]刘 朝,管 生,李明省,等.肝脏肿瘤介入术后碘油异位脑栓塞（附报道２例并文献复习）[J].介入放射学杂志,2011,(02):135-137.
　LIU Chao,GUAN Sheng,LI Ming-xing,et al.Cerebral lipiodol embolism caused by interventional therapy for hepatic tumor report of two cases with literature review[J].journal interventional radiology,2011,(02):135-137.
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肝脏肿瘤介入术后碘油异位脑栓塞（附报道２例并文献复习）()

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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2011年02期
页码:
135-137
栏目:
临床研究
出版日期:
2011-03-15

文章信息/Info

Title:
Cerebral lipiodol embolism caused by interventional therapy for hepatic tumor report of two cases with literature review
作者:
刘 朝;  管 生;  李明省;  马 南;  张建好;  胡小波;  王志伟
450052  河南郑州 郑州大学第一附属医院放射介入科二病区
Author(s):
LIU Chao;  GUAN Sheng;  LI Ming-xing;  MA Nan;  ZHANG Jian-hao;  HU Xiao-bo;  WANG Zhi-we
Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
关键词:
脑栓塞; 　碘油; 　肝脏肿瘤; 　介入治疗
分类号:
Ｒ５４３.６
文献标志码:
Ｂ
摘要:
目的 探讨碘油脑栓塞（ｃｅｒｅｂｒａｌ ｌｉｐｉｏｄｏｌ ｅｍｂｏｌｉｓｍ，ＣＬＥ）的可能发生机制及预防措施。方法 通过回顾分析本治疗中心２例碘油脑栓塞患者的临床及影像学发现，检索国内外文献，归纳整理，总结其共性，探讨其发生机制及可能的预防措施。结果 肝脏介入术后碘油异位脑栓塞国内外共有报道１７例，资料较详细的为１５例，附带本文提供的２例病人，归纳总结了１７例患者，肿瘤位于肝顶部肿瘤１２例，其他部位肿瘤２例，另３例不详；其中巨块状肿瘤１５例，其他类型肿瘤２例。ＴＡＣＥ治疗１６例，经皮瘤内注药治疗１例。１１例碘油用量超过２０ ｍｌ。合并肺栓塞的１３例。１５未发现异常动静脉通路，２例发现异常动静脉通路。８例最终症状完全消失，６例症状部分缓解，３例死亡。结论 碘油用量过大、肺血窦开放或肺异常动静脉分流道形成可能与其有直接关系，近肝顶部巨大富血供肿瘤的多次介入治疗也可能是其潜在的危险因素。个体化控制碘油用量及评估病灶血供及异常动静脉通路，使用新型栓塞剂如已在临床开始使用的药物洗脱微粒可能会降低ＣＬＥ的发生率。

参考文献/References:

[1] Sakamoto I, Aso N, Nagaoki K, et al. Complications associated with transcatheter arterial embolization for hepatic tumors[J]. Radiographics, 1998, 18: 605 - 619
[2] Nelson B, Rush EA, Takasugi M, et al. Lipid embolism to the brain after lymphography[J]. N Engl J Med, 1965, 273: 1132 - 1134.
[3] Appenrodt B, Schepker M, Kunts-Hehner S, et al. A patient with portal hypertension and blindness after transjugular intrahepatic portal systemic shunt[J]. Eur J Gastroenterol Hepatol, 2006, 18: 447 - 449.
[4] 李安敏, 周 石, 王荣品, 等. 肝癌化疗栓塞致碘油脑栓塞1例[J]. 上海医学影像学杂志, 2001, 10: 113 - 114.
[5] 崔艳峰, 祖茂衡, 徐 浩, 等. 肝细胞癌TACE术后严重并发症分析[J]. 中国介入影像与治疗学, 2005, 2, 31 - 33.
[6] 张 帆, 张 璟, 商海峰, 等. 肝癌介入治疗的严重并发症——碘油脑栓塞[J]. 当代医学, 2009, 3: 70 - 72.
[7] Wu JJ, Chao M, Zhang GQ, et al. Delayed cerebral lipiodol embolism after transcatheter arterial chemoembolization of hepatocellular carcinoma[J]. Chin Med J(Engl), 2009, 122: 878 - 880.
[8] Choi CS, Kim KH, Seo GS, et al. Cerebral and pulmonary embolisms after transcatheter arterial chemoembolization for hepatocellular carcinoma[J]. World J Gastroenterol, 2008, 14: 4834 - 4837.
[9] Lu Wu, Ye-Fa Yang, Jun Liang, et al. Cerebral lipiodol em-bolism following transcatheter arterial emboliazation for hepatocellular carcinoma[J]. World J Gastroenterol, 2010, 16: 398 - 402.
[10] Lee CS, Kim SJ, Choi JN, et al. Cerebral lipiodol Embolism Proven by Dual-Energy Computed Tomography: A Case Report[J]. J Comput Assist Tomogr, 2010, 34: 105 - 106.
[11] Matsumoto K, Nojiri J, Takase Y, et al. Cerebral lipiodol em-bolism: a complication of transcatheter arterial chemoemboliza-tion for hepatocellular carcinoma[J]. Cardiovasc Intervent Radiol, 2007, 30: 512 - 514.
[12] Pil Jin Chung, Seon-Young Park, Young-Il Kim, et al. Cerebral lipiodol embolism after transcatheter arterial chemoembolization[J]. Korean J Gastroenterol, 2009, 54: 130 - 134.
[13] Wu Jian jun, Ming Chao, et al. Pulmonary and cerebral lipiodol embolism after transarterial chemoembolization[J]. World J of Gastroenteral, 2009, 15: 633 - 635.
[14] Chang Song Choi, Ki Hoon Kim, Geom Seog Seo, et al. Cerebral and pulmonary embolisms after transcatheter arterial chemoembolization for hepatocellular carcinoma[J]. World J Gastroenterol, 2008, 14: 4834 - 4837.
[15] Sevitt S. The significance and pathology of fat embolism[J]. Ann Clin Res, 1977, 9: 173 - 180.
[16] Yamada R, Kishi K, Sato M, et al. Transcatheter arterial chem-oembolization in the treatment of unresectable hepatocellular carcinoma[J]. World J Surgery, 1995, 19: 795 - 800.
[17] Kishi K, Sonomura T, Satoh M, et al. Acute toxicity of lipiodol infusion into the hepatic arteries of dogs[J]. Invest Radiol, 1994, 29: 882 - 889.
[18] Sato M, Kishi K, Shioyama Y, et al. Effects of experimental hepatic artery embolization with lipiodol and gelatin sponge on liver tissue[J]. Nippon Igaku Hoshasen Gakkai Zasshi, 1990, 50: 107 - 113.
[19] Yoon W, Kim JK, Kim YH, et al. Bronchial and non-bronchial systemic artery embolization for life-threatening hemoptysis: a comprehensive review[J]. Radiographics, 2002, 22: 1395 - 1409.



 

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备注/Memo

备注/Memo:
收稿日期：２０１００９０６
更新日期/Last Update: 2011-03-15