摘要
目的探讨肝细胞癌（HCC）肝动脉化疗栓塞（TACE）术后胆汁瘤形成的危险因素、治疗及预后。方法回顾性分析2011年1月至2013年12月在中山大学附属第三医院行TACE治疗的HCC患者481例，分析胆汁瘤发生的危险因素、临床特点、治疗及预后。结果术前合并胆道扩张、肝切除史、非超选择性插管和使用聚乙烯醇（PVA）颗粒是TACE术后胆汁瘤发生的危险因素。其中43例（8．9％）发生胆汁瘤，9例（1．9％）为有症状胆汁瘤，均进行了经皮穿刺胆汁瘤置管引流，其中7例缩小，2例消失；35例（7．3％）为无症状胆汁瘤，均进行了随访观察，其中24例无变化，8例缩小，2例消失，1例胆汁瘤明显增大，破入腹腔形成胆汁性腹膜炎，死于肝功能衰竭、感染性休克。结论合并胆道扩张、有肝切除史、术中使用PVA颗粒、非超选择性插管是肝癌TACE术后胆汁瘤形成的危险因素。有症状胆汁瘤，应及时经皮穿刺置管引流，预后良好；无症状胆汁瘤，需定期影像学随访，对于明显增大者，应及时经皮穿刺置管引流。
Objective To explore the risk factors, treatment and outcomes of biloma after transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （HCC）. Methods A total of 481 patients with a diagnosis of HCC underwent TACE at our hospital from January 2011 to December 2013. Biloma was tracked by the follow-ups of computed tomography or magnetic resonance imaging （ CT/ MRI）. Retrospective analyses were conducted for their clinical features, treatments and prognosis. The statistically significant factors for univariate analysis were introduced into Logistic regression models for muhivariate analysis to obtain the risk factors of biloma post-TACE. Results There were 43 eases of complicated biloma after TACE. And 38 patients （88.4%） developed biloma at 0. 5 -3 months post-TACE while another 5 （9.7%） did so at 3 -5 months. The multivariate analysis showed that bile duct dilation, a history of hepatectomy prior to TACE, use of polyvinyl alcohol （ PVA ） particles and nonsuperselective embolization were the risk factors of biloma formation after TACE. Among 9 symptomatics, there were jaundice （ n = 2 ） and fever （ n = 7 ）. The diameter of bilomas was （ 8. 07 ＋ 3.53 ） cm for 9 symptomaties and （2. 81 ＋ 1.26 ） cm for 35 asymptomatics. And the difference was statistically significant （P 〈 0.01 ）. Nine symptomatic patients underwent percutaneous drainage with tube and biloma diminished （ n = 7 ） and even vanished （ n = 2）. Only conservative treatment was offered for 35 asymptomatics. During the follow-ups, it showed no change （ n = 24 ）, diminishing （ n = 8 ） and disappearance （ n = 2 ）. One case died from a greatly enlarged biloma due to hepatic failure and septic shock via a rupture into abdominal cavity and choleperitonitis. Conclusion The risk factors of biloma formation after TACE for HCC are bile duct dilation, a history of hepatectomy before TACE, use of PVA particles and nonsuperselective embolization. For symptomaties, drainage must be performed timely and the prognosis is fair. For asymptomaties, regular imaging follow-ups are needed. Drainage must be performed timely when the diameter of biloma increased significantly during the follow-ups.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2015年第13期1002-1005,共4页
National Medical Journal of China
基金
国家自然科学基金面上项目（81371655）
广州市科技计划项目（2013J4100118）
关键词
肝肿瘤
栓塞
治疗性
胆汁瘤
Liver neoplasms
Embolization,therapeutic
Biloma
