Carretero Cristina, Munoz-Navas Miguel, Betes Maite, Angos Ramon, Subtil Jose C, Fernandez-Urien Ignacio, De la Riva Susana, Sola Josu, Bilbao Jose I, de Luis Esther, Sangro Bruno
Department of Gastroenterology, Liver Unit, University Clinic of Navarra, Navarra, Spain.
Am J Gastroenterol. 2007 Jun;102(6):1216-20. doi: 10.1111/j.1572-0241.2007.01172.x. Epub 2007 Mar 13.
Radioembolization is a new tool for the treatment of hepatic tumors that consists in the injection of biocompatible microspheres carrying radioisotopes into the hepatic artery or its branches.
We have performed radioembolization in 78 patients with hepatic tumors using resin-based microspheres loaded with yttrium-90. All patients were previously evaluated to minimize the risk of hazardous irradiation to nontarget organs and to obtain the data needed for dose calculation.
We report a complication found in three cases (3.8%) that consists of abdominal pain resulting from gastroduodenal lesions and that had a chronic, insidious course. Microscopically, microspheres were detected in the specimens obtained from all affected gastric areas. Since these gastroduodenal lesions do not appear when nonradiating microspheres are injected in animals, lesions are likely to be due to radiation and not to an ischemic effect of vascular occlusion by spheres.
We believe that a pretreatment evaluation that includes a more thorough scrutiny of the hepatic vascularization in search of small collaterals connecting to the gastroduodenal tract can help prevent this awkward complication.
放射性栓塞是一种治疗肝肿瘤的新方法，其操作是将携带放射性同位素的生物相容性微球注入肝动脉或其分支。
我们使用负载钇-90的树脂基微球对78例肝肿瘤患者进行了放射性栓塞治疗。所有患者之前均经过评估，以尽量降低对非靶器官进行有害照射的风险，并获取剂量计算所需的数据。
我们报告了3例（3.8%）出现的并发症，表现为因胃十二指肠病变导致的腹痛，且病程呈慢性、隐匿性。显微镜检查发现，从所有受影响的胃部区域获取的标本中均检测到微球。由于在动物体内注射无放射性微球时不会出现这些胃十二指肠病变，因此这些病变可能是由辐射引起的，而非微球导致血管闭塞的缺血效应。
我们认为，预处理评估包括更彻底地检查肝血管化情况以寻找连接胃十二指肠的小侧支血管，有助于预防这种棘手的并发症。
