肝动脉化疗后胃十二指肠溃疡：亚甲蓝内镜在疼痛调查中的作用。
Gastroduodenal ulceration following hepatic arterial chemotherapy: the role of methylene blue endoscopy in the investigation of pain.
机构信息
Liver Unit, UNSW Department of Surgery, St George Hospital, Sydney, Australia.
出版信息
HPB (Oxford). 2002;4(1):29-34. doi: 10.1080/136518202753598708.
BACKGROUND
Unintended perfusion of the gastroduodenum may complicate hepatic arterial chemotherapy leading to mucosal ulceration.
PATIENTS AND METHODS
In a review of 233 consecutive hepatic artery catheters placed, 61 patients were investigated for chemotherapy-related epigastric pain. Investigations included catheter imaging, upper gastrointestinal endoscopy with methylene blue injection via the hepatic artery catheter and angiography.
RESULTS
Twenty patients (33%) demonstrated blue staining of the gastroduodenum. Angiography performed in 15 of these patients confirmed a misperfusing vessel in 13.The aberrant artery was successfully embolised and infusional chemotherapy recommenced in 11 patients. Forty-one patients had a negative dye test, of whom three had gastroduodenal ulcers, 14 had oesophagitis or gastroduodenitis, ten had catheter complications (leak n=2, arteritis n=5, pseudoaneurysm n=1, sepsis n=1), three had liver collections, five had floxuridine cholangitis and one had myocardial ischaemia. No cause could be found in 8 patients. No patient with a negative dye test developed unintended perfusion on repeat investigation.
背景
未预期的胃十二指肠灌注可能使肝动脉化疗复杂化，导致黏膜溃疡。
患者和方法
在对 233 例连续进行的肝动脉导管放置进行回顾性研究中，对 61 例因化疗相关上腹痛而接受检查的患者进行了研究。检查包括导管成像、经肝动脉导管注入亚甲蓝的上消化道内镜检查和血管造影。
结果
20 例（33%）患者胃十二指肠出现蓝色染色。对其中 15 例患者进行血管造影检查，证实有 13 例存在异常灌注血管。异常动脉成功栓塞，11 例患者重新开始输注化疗。41 例患者的染料试验为阴性，其中 3 例有胃十二指肠溃疡，14 例有食管炎或胃炎，10 例有导管并发症（漏 n=2，动脉炎 n=5，假性动脉瘤 n=1，脓毒症 n=1），3 例有肝脓肿，5 例有氟尿嘧啶胆管炎，1 例有心肌缺血。8 例患者未发现病因。重复检查未发现染料试验阴性的患者存在意外灌注。
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