肝肿瘤TACE后并发肝脓肿和胆汁瘤的诊治

Diagnosis and Therapy of Liver Abscess and Biloma after TACE for Hepatic Carcinoma

目的探讨肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)后并发肝脓肿和胆汁瘤的诊断方法和应用经皮肝穿刺外引流术加抗生素灌(冲)洗治疗的疗效。方法2005年8月～2008年8月行TACE治疗的肝癌患者589例,并发肝脓肿6例和胆汁瘤2例,其中4例肝脓肿和2例胆汁瘤行经皮肝穿刺外引流术和抗生素灌(冲)洗,2例肝脓肿行保守治疗。结果4例肝脓肿行经皮肝穿刺外引流术和抗生素灌(冲)洗治疗后临床症状明显改善,脓(瘤)腔均有不同程度缩小,2例保守治疗无效,于发病后4d和28d死亡;2例胆汁瘤临床症状改善,1例瘤腔缩小,1例瘤腔无变化。结论肝癌TACE并发肝脓肿和胆汁瘤,应根据其临床及影像学特征,灵活运用多种方法综合诊断,而经皮肝穿刺外引流术和抗生素灌(冲)洗是相对有效的治疗方法之一。

Objective To explore the diagnostic ways of liver abscess and biloma after TACE and the curative effects of percutaneous transhepatic catheter drainage plus lavage or swash with antibiotics. Methods Among the 589 cases of hepatic carcinoma taken TACE between August 2005 and August 2008, there were altogeth- er 6 cases of liver abscess and 2 cases of biloma complicated. The clinical and imaging features of the above 8 patients were summarized. Percutaneous transhepatic catheter drainage plus lavage or swash with antibiotics was performed in 4 cases of liver abscess and 2 cases of biloma, expectant treatment was used in the other 2 liver abscess cases, and the therapeutic effect was observed. Results The clinical symptoms of 4 cases of liver abscess were obviously improved after percutaneous transhepatic catheter drainage plus lavage or swash with antibiotic, but the other 2 cases of liver abscess who received expectant treatment died after 4 and 28 days respectively. In the two biloma patients who also got drainage and lavage, the symptoms were obviously improved, one biloma cavity became smaller and the other remained without diminution. Conclusion Different measures should be taken to diagnosis of liver abscess and biloma after TACE according to the clinical and imaging features. Percutaneous transhepatic catheter drainage plus lavage or swash with antibiotics is a relatively effective therapeutic measure.