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目的探讨和分析肝动脉栓塞化疗(TACE)治疗原发性肝癌过程中发生碘化油脑栓塞(CLE)的机制,并探寻相应的预防和治疗措施。方法收集广东省人民医院介入科2例原发肝癌患者TACE术后出现CLE的临床资料,并结合国内外相关文献报道34例,探讨TACE在治疗原发性肝癌过程中发生碘化油脑栓塞的发生机制、预防及治疗措施。结果 2例患者均非首次TACE治疗过程中出现CLE,2例患者均为膈下巨块型肝癌。收集国内外病例36例,其中接受TACE 4次及以上10例(27.8%);碘化油用量≥20 ml 19例(52.8%);巨块肿瘤(直径≥10 cm)15例(41.7%)。结论碘化油脑栓塞是肝癌患者接受TACE治疗时罕见而又严重的并发症,TACE治疗次数、碘化油用量、巨块型肿瘤、膈下动脉供血可能与其发生有直接关系。CLE应以预防为主,一旦发生应积极抢救治疗,可获得较好恢复。
Objective To investigate and analyze the mechanism of hepatic arterial chemoembolization (IACE) in the treatment of primary hepatocellular carcinoma (HCC) caused by iodinated oil occlusion (CLE) and explore the corresponding preventive and therapeutic measures. Methods The clinical data of CLE after TACE in two cases of primary hepatocellular carcinoma in Guangdong Provincial People’s Hospital were collected. In combination with 34 cases reported in literatures at home and abroad, we discussed the clinical significance of TACE in the treatment of primary hepatic carcinoma Mechanism, prevention and treatment measures. Results None of the two patients presented with CLE during the first TACE treatment, and 2 patients were all subhepatic bulky hepatocellular carcinoma. Thirty-six cases were enrolled in this study, of which 10 (27.8%) were treated with TACE 4 or more times, 19 cases (52.8%) with iodized oil ≥ 20 ml, and 15 (41.7% . Conclusion The iodized oil occlusion is a rare and serious complication of TACE in patients with hepatocellular carcinoma. The number of TACE treatment, the dosage of iodized oil, massive tumor and subphrenic artery blood supply may be directly related to its occurrence. CLE should be based on prevention, in the event of active treatment should be rescued, get a better recovery.