摘要
目的:探讨海藻酸钠微球栓塞治疗肝细胞癌(hepatocellular carcinoma,HCC)术后合并肝脓肿的临床特点、可能机制与其结局.方法:回顾性分析2008-01/2013-01我院收治的以海藻酸钠微球(kelp microgelation,KMG)栓塞治疗后合并肝脓肿的HCC患者的临床资料.结果:583例患者应用KMG栓塞治疗,每例1-4次,总计1749例次,其中9例块状型HCC术后发生了肝脓肿.典型临床表现为术后9-23 d内出现的不同程度的肝区疼痛症状,同时伴或不伴驰张高热和寒战症状;实验室检查可见白细胞显著升高,影像检查可见肝内脓肿形成表现.分析其可能机制:HCC与肝内胆管供血动脉分支之间血管解剖因素、KMG的理化特性、瘤体血供丰富程度、肿瘤负荷和栓塞剂量、栓塞技术、局部微环境与肠道菌群等为重要的影响因素.依据影像检查结果,及时实施充分引流并联合敏感抗生素系统、足量、足疗程抗炎综合治疗后,在2 wk-2 mo内痊愈.结论:应用KMG经肝动脉栓塞治疗HCC时,在富血供、块状型病例中,使用剂量过大或栓塞过多正常组织时有可能导致肝脓肿发生,值得引起临床关注.
AIM： To analyze the clinical characteristics, pos- sible mechanisms and outcomes of liver abscess after transcatheter arterial embolization （TAE） with kelp micro gelatin （KMG） in patients with hepatocellular carcinoma （HCC）. METHODS： Clinical data for HCC patients who were treated with KMG embolization and later developed liver abscess at our hospital from Jan- uary 2008 to January 2009 were retrospectively reviewed.RESULTS： In total, 583 HCC patients under- went TAE with KMG. TAE was given to each patient 1 to 4 times, with a total of 1749 times. Nine patients with massive HCC developed liv- er abscess. Typical clinical manifestations were varying degrees of liver pain on postoperative days 9-23, with or without remittent fever and chills. Main laboratory finding was a significant increase in white blood cells, and imaging ex- aminations revealed signs of liver abscess. Fac- tors possibly causing the development of liver abscess included the anatomic characteristics of blood vessels between the branches of HCC feeding arteries and intrahepatic bile duct feed- ing arteries, the physical and chemical proper- ties of KMG, a hypervascular tumor, tumor bur- den, dose of embolic agent, embolization tech- nique, local microenvironment and intestinal flora. Based on imaging findings, the following treatments could be given： timely and adequate drainage combined with anti-inflammatory therapy using full dose of effective antibiotics for sufficient course. The 9 patients recovered in 2 weeks to 2 months after treatment. CONCLUSION： The development of liver ab- scess should be monitored in HCC patients un- dergoing TAE with KMG, especially when the tumor is hypervascular or massive, or when the patient consumes an excessive dose of KMG or too much normal tissue was embolized.
出处
《世界华人消化杂志》
CAS
北大核心
2013年第31期3422-3428,共7页
World Chinese Journal of Digestology
关键词
海藻酸钠微球
肝细胞癌
选择性肝动脉
栓塞术
肝脓肿
Kelp micro gelatin
Hepatocellular car-cinoma
Transarterial embolization
Liver abscess
