乏血供肝脏肿瘤经肝动脉化疗栓塞后胆汁瘤形成(附11例报道)

The biloma formation after transarterial chemoembolization in hypovascular hepatic tumors (11 cases reports)

目的研究肝脏肿瘤经动脉化疗栓塞（TACE）后胆汁瘤形成的原因及处理方法。方法11例肝脏肿瘤经动脉化疗栓塞后胆汁瘤形成的患者,记录患者胆汁瘤形成前有无黄疸及处理方法,胆汁瘤形成前TACE次数,碘油栓塞后沉积表现,胆汁瘤形成时间,穿刺引流及预后。结果胆管癌患者5例,肝癌4例,结肠癌肝转移2例。胆汁瘤形成前有黄疸者7例,7例曾有经皮穿肝胆道引流术（PTCD）及胆道支架植入史。TACE次数平均值为3次（1~5次）,碘油沉积散在淤滞于肝动脉。胆汁瘤形成于末次TACE后2~4周,7例穿刺引流证实胆汁瘤与胆道相通。7例同时接受PTCD者胆汁瘤愈合,3例未接受PTCD者,胆汁瘤引流管无法拔除,另1例死于引流后1月肾功能衰竭。结论胆汁瘤形成与TACE中碘油栓塞、淤滞有关。胆汁瘤引流非常重要,部分患者PTCD可降低胆道压力加速胆汁瘤愈合。

Objective To study the reasons of biloma formation and prognosis after transarterial chemoembolization （TACE） in hepatic tumors. Methods Eleven cases with biloma after TACE were analysed for reasons of formation and prognosis after treatment. Presence of jaundice before times of TACE, iodized oil （lipiodol） deposition, time between the last TACE and biloma formations, puncture drainage were recorded. All the patients were followed up continuously. Results Among 11 cases, 5 were diagnosed as cholangioma, 4 were primary hepatic carcinoma, and 2 were colorectal cancer with liver metastasis. Seven cases had pre-biloma jaundices, 3 cases of which had surgical operations, all of them received percutaneous transhepatic cholangiography and drainage （PTCD） and stents input. All the patients had an average of 3 times of TACE before biloma formations （range 1 to 5） with the presence of lipiodol diffuse deposition in liver parenchyma. Biloma formations occurred at about 2 to 4 weeks after last TACE and 7 of them were confirmed as connecting with biliary tracts by cholangiography. Seven patients （63 %0） who received PTCD had bilomas shrunk. Another 3 cases without PTCD failed with drainage tubes pulled out. One case died from renal function failure after 1 month. Conclusions It is proposed that over lipiodol embolization could be the key point of biloma formation. Drainage of biloma is very important, therefore, PTCD is possibly useful to decrease the pressure in bile tube and beneficial for some patients.