Collins Jeremy, Salem Riad
Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois.
Semin Intervent Radiol. 2011 Jun;28(2):240-5. doi: 10.1055/s-0031-1280673.
Gastric ulceration is a relatively uncommon but well-described complication of yttrium 90 (Y90) radioembolization therapy in the locoregional treatment of hepatic tumors. Meticulous attention to vascular anatomy, an assessment of antegrade hepatic arterial flow, and knowledge of the dynamic embolic effect of the chosen Y90 particulate at treatment are requirements to reduce the risk of nontarget embolization to gastrointestinal structures. Radiation-associated gastrointestinal ulceration is difficult to treat, and may be associated with gastrointestinal bleeding, bowel obstruction, and perforation. Surgical excision of the involved segment with bypass may be necessary. The increased use of coil embolization of at-risk vessels combined with administration of Y90 particulates with minimal embolic effect has reduced the incidence of radioembolization associated gastrointestinal ulceration.
胃溃疡是钇90（Y90）放射性栓塞治疗肝肿瘤局部区域时一种相对少见但已有详细描述的并发症。在治疗时，需格外关注血管解剖结构、评估肝动脉顺行血流，并了解所选Y90微粒的动态栓塞效果，以降低胃肠道结构发生非靶栓塞的风险。放射性相关的胃肠道溃疡难以治疗，可能伴有胃肠道出血、肠梗阻和穿孔。可能需要对受累节段进行手术切除并搭桥。对有风险的血管增加使用线圈栓塞，并联合使用栓塞作用最小的Y90微粒，已降低了放射性栓塞相关胃肠道溃疡的发生率。
