经导管肝动脉化疗栓塞术后并发肝内胆管损伤  

Intrahepatic biliary injury caused by transcatheter arterial chemoembolization in patients of hepatic malignancies

作　　者：梁军[1] 杨业发[1] 葛乃建[1] 申淑群[1] 伍路[1] 吴孟超[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院放射介入一科,上海200438

出　　处：《中华普通外科杂志》2010年第7期566-568,共3页Chinese Journal of General Surgery

摘　　要：目的 探讨肝脏恶性肿瘤经导管肝动脉化疗栓塞术后并发肝内胆管损伤的影像学表现及临床诊治方法.方法 收集2007年9月至2009年3月因肝脏恶性肿瘤行经导管肝动脉化疗栓塞术1302例的临床资料,术前影像学检查均无明显胆道异常,观察术后肝内胆管影像学征象及临床表现.结果 6例经导管肝动脉化疗栓塞术后随访1至3个月出现肝内胆管损伤,其中2例出现黄疸、高热等胆道梗阻、感染症状,采用经皮经肝胆道穿刺引流术后症状缓解 其余4例仅有影像学改变,无明显临床症状.结论 肝内胆管损伤是经导管肝动脉化疗栓塞术后少见的并发症,诊断依赖于临床表现及影像学检查,经皮经肝胆道穿刺引流术是有症状的肝内胆管损伤的有效治疗方式.Objective To evaluate CT findings, diagnosis and management of intrahepatic biliary injuries after transcatheter arterial chemoembolization （TACE） for liver malignancies. Methods A total of 1302 patients with hepatic malignant tumors received TACE between Sep 2007 and Mar 2009. None of these patients were found to have any radiographic evidence of biliary abnormalities before TACE. A retrospective review of imaging studies and clinical outcomes was carried out to evaluate the changes of intrahepatic biliary injuries after TACE. Results Six patients developed intrahepatic biliary injuries during 1 and 3-month follow-up. Two cases with jaundice and high fever, underwent percutaneous transhepatic cholangiography and drainage and eventually recovered. The other 4 patients were asymptomatic with only radiographic changes and were managed observationally. Conclusions Intrahepatic biliary injury is a rare complicating TACE procedures. It will be identified by clinical outcomes and radiographic imaging findings. Percutaneous transhepatic cholangiography and drainage （PTCD） is the therapy of choice for intrahepatic biliary injuries with jaundice or high fever.

关 键 词：胆管疾病 栓塞 治疗性 手术后并发症 肝肿瘤 

分 类 号：R735.7[医药卫生—肿瘤]