胆汁瘤的形成原因及介入治疗

Intrahepatie biloma formation and its interventional treatment

目的探讨肝内胆汁瘤形成的因素及介入治疗方法。方法我们共发现6例胆汁瘤患者,其中4例在经皮经肝胆道穿刺引流术(Percutaneous transhepatic cholangial drainage,PTCD)过程中遇到的胆汁瘤患者,2例与肝内胆管相通的患者行胆道成行内引流术,1例与肝内胆道不相通的患者行外引流术,1例因患者肿瘤广泛转移,身体基础情况较差未做处理。另外2例在我们对2007年2月～2008年9月246例接受TAE(transcatheter arterial embolization)和/或PEI(percutaneous ethanol injection)治疗的中晚期肝癌患者进行CT随访回顾性复习时发现的,并给予保守治疗。分析TAE(经导管肝动脉化疗栓塞)和PEI(经皮肝穿刺癌灶内无水酒精注射术)治疗与胆汁瘤的关系。结果PTCD过程中发现4例胆汁瘤,且均呈囊状扩张。其中2例行胆道成行内引流术,1例外引流术,患者症状明显改善,1例因患者肿瘤广泛转移,身体基础情况较差未处理。2例介入手术后胆汁瘤患者胆汁瘤较小且无明显临床症状,给予内科保守治疗。结论胆汁瘤是肝胆手术、肝癌介入治疗、外伤等所致的一种并发症。其诊断有赖于影像学检查。肝内胆道成型术、外引流、支架放置和酒精消融是可选择的治疗方法。

Objective： The purpose of our study was to discuss the factor of intrahepatie biloma and its interventional treatment. Methods： Six cases were enrolled in the study. Four cases were diagnosed while PTCD. Two hundred forty-six patients with hepatic carcinoma underwent chemoembotization during February 2007 to September 2008. We retrospectively reviewed the medical records and follow-up CT / B-type ultrasonic inspection/MRI, 2 cases were found. We analyzed the factors associated with the formation of intrahepatic biloma. Results： Intrahepatic biloma developed after TACE/PEI in 2 patients in our series and 4 case were found while PTCD. Three cases had drainage while PTCD. Two cases had medical treatment. Conelution： Intrahepatic biloma formation is one of the major complications after Hepatobiliary Surgery/transcatheter arterial chemoembolization/trauma. The correct diagnosis depends on the imaging procedures. Drainage, stent placement, and ethanol ablation may be the choice of management.