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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2015, Vol. 03 ›› Issue (03) : 140 -143. doi: 10.3877/cma.j.issn.2095-5782.2015.03.007

所属专题： 文献；

肿瘤介入

胸廓内动脉参与肝癌供血介入栓塞后皮肤损伤的发生及预防
宋鹏1, 吴宁1,†(), 林福煌1, 李斯锐1, 陈峰1   
  1. 1. 570311　海口，海南省人民医院放射介入科
  • 收稿日期:2014-11-04 出版日期:2015-08-01
  • 通信作者: 吴宁

Skin injury after embolization of ITA participating in blood supply of liver cancer

Peng Song1, Ning Wu1,†(), Fuhuang Lin1, Sirui Li1, Feng Chen1   

  1. 1. Department of Interventional Radiology, Hainan General Hospital, Haikou 570311, China
  • Received:2014-11-04 Published:2015-08-01
  • Corresponding author: Ning Wu
  • About author:
    Corresponding author: Wu Ning, Email:
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宋鹏, 吴宁, 林福煌, 李斯锐, 陈峰. 胸廓内动脉参与肝癌供血介入栓塞后皮肤损伤的发生及预防[J]. 中华介入放射学电子杂志, 2015, 03(03): 140-143.

Peng Song, Ning Wu, Fuhuang Lin, Sirui Li, Feng Chen. Skin injury after embolization of ITA participating in blood supply of liver cancer[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2015, 03(03): 140-143.

目的

探讨胸廓内动脉（ITA）参与肝癌供血行介入栓塞治疗后皮肤损伤的发生特点及预防措施。

方法

对26例经血管造影确认有ITA参与肝癌供血者行ITA栓塞治疗。26例患者既往行TACE治疗2～6次，5例有肝切除病史。其中16例用碘油-抗癌药物乳剂栓塞，10例用碘化油及明胶海绵颗粒进行栓塞。8例用微导管行超选择性肿瘤供血动脉栓塞。术后观察并随访患者前胸壁及肝区皮肤变化。

结果

26例患者ITA参与肝癌供血者，右侧ITA 24例，左侧ITA 3例。19例介入治疗后出现不同程度前胸壁及肝区皮肤灼热感或针刺样疼痛。5例出现明显皮肤损伤，其中3例损伤皮肤出现破溃，1例继发感染。5例患者均应用碘油-抗癌药物乳剂行非选择性ITA栓塞。随诊1～4个月后5例均结痂愈合。

结论

皮肤损伤是经导管介入栓塞ITA的常见并发症，应用碘油-抗癌药物乳剂非选择性栓塞ITA是造成皮肤损伤的主要原因。

关键词: 皮肤损伤, 肝肿瘤, 胸廓内动脉, 动脉造影, 栓塞，治疗性
Objective

To explore the characteristics and the preventive measures of skin injury after interventional embolization of internal thoracic artery (ITA) participating in the blood supply of liver cancer.

Methods

ITA embolization was performed in 26 hepatic carcinoma patients confirmed to be the tumor blood supply arteries by angiography. All of the 26 patients had received TACE treatment for 2 to 6 times, and 5 of them had received liver resection. A total of 16 patients received ITA embolization by lipiodol antineoplastic emulsion, but lipiodol and Gelfoam were used in the other 10 patients. Eight cases received super selective embolization with micro-catheter. Observe and follow-up the change of the anterior chest wall skin.

Results

Twenty-four of the 26 patients received RITA embolization, 3 received LITA embolization, and 1 patient received both RITA and LITA embolization. After interventional therapy, 19 patients experienced different degree of burning sense and stabbing pain in the skin of anterior chest wall and liver area. Obvious skin injury occurred in 5 cases, and 3 of them appeared damaged skin rupture, and 1 case got secondary infection. All of the 5 patients got non-selective ITA embolization with lipiodol antineoplastic emulsion, and they all healed in 1—4 months.

Conclusions

Non-selective ITA embolization with lipiodol antineoplastic emulsion is the main cause of the skin damage.

Key words: Skin injury, Liver neoplasms, Internal thoracic artery, Angiography, Embolization, therapeutic
图1 患者男，47岁,肝癌，既往行4次TACE，RITA造影可见肝内多发肿瘤染色（箭，A），用碘油-抗癌药物乳剂行非超选择性栓塞治疗后第6天,肝区可见明显的皮肤损伤（箭，B）局部伴有水泡
图2 患者男，53岁,肝癌，既往行3次TACE，LITA造影可见肝内肿瘤染色（箭，A），将同轴微导管超选择性插至肿瘤供血分支（肌膈动脉，箭）行超选择性栓塞治疗后，病变碘油聚集良好（箭，B），术后未见皮肤损伤
表1 不同栓塞技术皮肤损伤统计
栓塞技术 病例数 疼痛 皮肤损伤 破溃
碘油-抗癌药物乳剂+超选择栓塞 8 3 0 0
碘油-抗癌药物乳剂+非超选择栓塞 8 8 5 3
纯碘油+非超选择栓塞 10 8 0 0
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