肝动脉化疗栓塞术后并发胆汁瘤11例分析

目的探讨肝癌化疗栓塞术(transcatheter arterial embolization,TAE)后肝内胆汁瘤形成的病理过程和临床意义。方法对450例接受TAE的中晚期肝癌患者进行CT随访,对疑有胆汁瘤的11例患者又行经皮肝穿刺胆汁瘤造影。结果发现11例胆汁瘤(11/450,2.4%)中,囊状扩张7例(7/11),柱状扩张4例(4/11)。10例行经皮肝穿刺胆汁瘤引流术,1例内科保守治疗好转。结论胆汁瘤是肝癌介入治疗后,由于胆管壁坏死所致的一种并发症,其诊断有赖于影像学检查,与残癌鉴别有助于进一步处理。外引流、支架放置和内科保守治疗,是可选择的治疗方法。

The Study on 11 Cases of Intrahepatic Biloma after Transcatheter Arterial Embolization Treatment

Objective To explore the cause and its significance of intrahepatic biloma after transcatheter arterial embolization treatment.Methods Four hundreds and fifty cases of hepatic cellular cancer(HCC) were followed up with CT examination after TAE,eleven cases received percutaneous bilomography.Results Eleven cases of biloma were found(11/450,2.4%),seven cases showed a cystic dilation(7/11),and four cases accompanied with a columnar dilation(4/11),seven cases were managed with PTD,symptoms of one case relieved with medical expectant treatment.Conclusion Biloma is one of the complications of the patients with HCC after TAE caused by the necrosis of the wall of biliary tract,the correct diagnosis depends on the imaging procedures.It is helpful to the further treatment to distinguish biloma from residual nidus of carcinoma.External drainage,stent placement,and medical expectant treatment may be the choice of management.