This is a question asked to me by a netizen. Paraplegia after liver cancer intervention is a sad thing for patients and their families. It is also a pity for doctors, because paraplegia after interventional treatment of liver cancer is one of the very rare complications of interventional treatment of liver cancer. As for whether it is a medical accident, I think netizens will know it after reading my analysis below.
Analysis from the perspective of liver cancer interventional technology:
Liver cancer interventional surgery is not complicated. As an experienced liver cancer interventional expert, it is impossible for him to violate the diagnosis and treatment standards for liver cancer interventional interventional surgery . Even for an inexperienced interventional doctor, he will not make mistakes that violate the diagnosis and treatment standards, because the hepatic artery is so easy to find, and interventional embolization of liver cancer can only be seen clearly under angiography. Even the risk of misdiagnosis and mistreatment is not easy. This could also explain why the patient had no problem with the first intervention. As we all know, the second interventional operation is more complicated than the first one. From my understanding, it is always done by experts with good skills. Experts with poor skills cannot do it even if they want to. Therefore, it is impossible to commit interventional treatment of in violation of diagnostic and treatment standards or misdiagnosis.
Liver cancer
Analysis from the anatomical characteristics of liver cancer and spine:
Under normal circumstances, 90%-95% of the blood supply of hepatocellular carcinoma comes from the hepatic artery, and a small part comes from the portal vein. In addition, the hepatic artery generally originates from the celiac artery. Even if the hepatic artery mutates, there are no branches from the vertebral artery. It is usually seen in the following situations:
- proper hepatic artery divides into the left, middle and right hepatic arteries in 55% of cases; replaces the left hepatic artery and originates from the left gastric artery in 10%;
- replaces the right hepatic artery and originates from the superior mesenteric artery in 11%;
- alternative left hepatic artery originates from the left gastric artery + alternative right hepatic artery originates from the superior mesenteric artery 1%;
- accessory left hepatic artery originates from the left gastric artery 8%;
- accessory right hepatic artery originates from the superior mesenteric artery 7%;
- The accessory left hepatic artery originates from the left gastric artery + the accessory right hepatic artery originates from the superior mesenteric artery 1%;
- replaces the right hepatic artery from the superior mesenteric artery + the accessory left hepatic artery originates from the left gastric artery 2%;
- origins from the common hepatic artery 2.5% originate from the superior mesenteric artery; 0.5% originate from the common hepatic artery from the left gastric artery.
Liver cancer
The arterial blood supply of the spine does not come from the hepatic artery. The blood supply of the anterior and posterior spinal arteries mainly comes from the vertebral artery. The radiculomedullary artery of the spine comes from the cervical vertebral artery and thyroid inferior, intercostal, main, internal iliac iliac External arterial branches supply blood, and after the radiculomedullary artery enters the spine, it forms the coronary artery ring of the spinal cord with the anterior and posterior vertebral arteries.
Judging from the anatomical characteristics of the blood supply of liver cancer and the hepatic artery and spinal artery, it is estimated that everyone can understand that under normal circumstances, the patient will not suffer from paraplegia after interventional treatment of liver cancer.
But why did the patient suffer such a tragedy as paraplegia after the second intervention?
seems to be related to the ideal first intervention for liver cancer. Because after the first liver cancer intervention is very successful, it often results in the liver cancer being unable to obtain tumor blood supply from normal channels. Therefore, in order to survive, liver cancer cells will form new blood vessel branches through the tumor's ability to regenerate blood vessels. Of course, it is also possible to open small hepatic collateral circulation that was not originally open to supply blood. This is why the first intervention for liver cancer is often perfect, but the cure cannot be achieved. And this also leaves the next safety hazard: the regenerated blood vessel branches or collateral circulation of liver cancer may form communicating branches with the blood supply branches of the hepatic artery and spine at the same time. This will pave the way for patients with paraplegia in future interventional treatments for liver cancer. .
Hepatic artery
When the blood supply vessel of liver cancer forms a communicating branch with the branch of vertebral artery, it is often not revealed during angiography of the blood supply artery of liver cancer because the injection pressure of contrast agent is not high. Therefore, the interventional expert simply does not know that the patient has a connection with the spine. The fact that arteries have communicating branches. Therefore, experts often perform re-embolization of the hepatic artery in accordance with operating standards and clinical experience. However, the embolization agent often requires a relatively high pressure to be injected into the blood supply branch of liver cancer. However, too high injection pressure will affect the spine and spine of the blood supply branch of liver cancer. For patients with the communicating branch, there will be two consequences: the first is that during the operation, it will be found that the embolic agent has entered the coronary artery ring of the spine, subsequently causing ischemia of the spinal cord. As a result, patients immediately experience numbness in their legs, and paraplegia is common after surgery. The second situation is that the patient is fine during and after the operation, but gradually the embolic agent enters the coronary artery loop of the patient's spine through the communicating branch, causing secondary spinal cord ischemia , which will also cause Patients show varying degrees of paraplegia.
The patient introduced by the netizen in the article is very likely to have the first situation introduced in the article. According to my understanding of Article 1224 of Civil Code , in this case, if the patient is harmed during diagnosis and treatment activities, the medical institution will not be liable for compensation. Naturally, it is not a hospital accident.
