肝动脉化疗栓塞术后胆管损伤的影像学研究  

Investigation of bile duct injury after transcatheter arterial chemoembolization

作　　者：王茂强[1] 邵如宏[1] 叶慧义[2] 王志强[3] 王仲朴[1] 刘凤永[1] 

机构地区：[1]解放军总医院介入医学科,北京100853 [2]解放军总医院放射诊断科,北京100853 [3]解放军总医院消化科,北京100853

出　　处：《中华肿瘤杂志》2005年第10期609-612,共4页Chinese Journal of Oncology

摘　　要：目的观察经导管肝动脉化疗栓塞术(TACE)治疗肝脏恶性肿瘤后继发胆管损伤的影像学表现.方法 1240例患者行TACE 2680次,18例于TACE术后3周～3个月出现胆管损伤.18例TACE前后均行CT和超声波检查,14例行MRI,15例行血管造影.对18例不同类型的肝脏恶性肿瘤TACE术后胆管损伤的发生率、影像学表现及导致胆管损伤的高危因素进行回顾性分析.结果肝转移性肿瘤TACE术后胆管损伤的发生率为8.8%(13/148),肝细胞性肝癌(HCC)胆管损伤的发生率为0.5%(5/1092).影像学表现为局灶性胆管扩张4例,多灶性肝段-亚段胆管扩张8例,巨大囊性病灶或胆汁瘤6例.胆管损伤区肝叶-段呈进行性萎缩6例.分析结果显示,TACE术后胆管损伤多发生于无肝硬变者的肝转移瘤患者(P<0.01);同时,使用铂类制剂与碘油乳化行TACE以及肿瘤为少血供型(P均<0.01),也是高危因素.结论 TACE后可出现局灶性、多灶性胆管扩张和胆汁瘤等胆管损伤表现;无肝硬变者是TACE后造成胆管损伤的主要危险因素.Objective To investigate the image findings of bile duct injury after transcatheter arterial chemoembolization （TACE） for hepatic malignancy. Methods During the past 3 years, 1240 patients with different hepatic malignancies had undergone a total of 2680 TACE procedures. Eighteen patients （1.4%）developed bile duct injuries from 3 weeks to 3 months after TACE. All of the 18 patients received follow-up CT and uhra-sonography, 14 MRI and 15 digital subtract angiography （DSA）. The image data was retrospectively reviewed, with the potential predisposing factors correlated to TACE-induced bile duct injury. Results TACE-induced bile duct injuries developed in 13 of 148 patients with liver metastasis （8.8%）, 5 of 1092 patients with hepatocellular carcinoma （HCC） （0.5%）. On image examination, focal peripheral intrahepatic bile duct dilatation was detected in 4 cases, multiple bile duct dilatations with segmental or sub-segmental distribution in 8, and a large lobular cystic lesion or biloma in 6 cases, and progressive atrophy of the corresponding hepatic parenchyma in 6 patients in whom the TACE induced-bile injury developed at different intervals after TACE. The incidence of bile duct injury was higher in noncirrhotic patients with metastatic liver lesions than in patients with hepatocellular carcinoma associated with cirrhosis （ P 〈0.01 ）, and it was also higher in patients using an emulsion of lipiodol-cisplatin or carboplatin than in patients using other emboliging agents （P 〈0.01 ）. The incidence was higher either in patients with hypovascular lesions than in patients with hypervascular lesions （ P 〈 0. 05 ）. Conclusion Biliary abnormalities, including focal and multiple intrahepatic bile duct dilatation, and cystic lesion or biloma, may develop and can be detected during the follow-up examination imaging in patients with hepatic malignancy after TACE. Noncirrhotic liver and intact function, due to the lack of peri-biliany collateral circulation, are the significant predispos

关 键 词：肝动脉化疗栓塞术 肝肿瘤 胆管损伤 影像学 

分 类 号：R735.7[医药卫生—肿瘤] R657.4[医药卫生—临床医学]