CAJ | 학술논문

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.
목적 탐토간세포암(HCC)간동맥화료전새(TACE)술후담즙류형성적위험인소、치료급예후.방법 회고성분석2011년1월지2013년12월재중산대학부속제삼의원행TACE치료적HCC환자481례,분석담즙류발생적위험인소、림상특점、치료급예후.결과 술전합병담도확장、간절제사、비초선택성삽관화사용취을희순(PVA)과립시TACE술후담즙류발생적위험인소.기중43례(8.9％)발생담즙류,9례(1.9％)위유증상담즙류,균진행료경피천자담즙류치관인류,기중7례축소,2례소실;35례(7.3％)위무증상담즙류,균진행료수방관찰,기중24례무변화,8례축소,2례소실,1례담즙류명현증대,파입복강형성담즙성복막염,사우간공능쇠갈、감염성휴극.결론 합병담도확장、유간절제사、술중사용PVA과립、비초선택성삽관시간암TACE술후담즙류형성적위험인소.유증상담즙류,응급시경피천자치관인류,예후량호;무증상담즙류,수정기영상학수방,대우명현증대자,응급시경피천자치관인류.
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 multivariate analysis to obtain the risk factors of biloma post-TACE.Results There were 43 cases 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 symptomatics 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 symptomatics,drainage must be performed timely and the prognosis is fair.For asymptomatics,regular imaging follow-ups are needed.Drainage must be performed timely when the diameter of biloma increased significantly during the follow-ups.