肝癌化疗栓塞并发肝脓肿的临床特点及易感因素分析

Clinical characteristics and predisposing factors for liver abscess formation after chemoembolization of hepatic malignancy

目的探讨肝癌患者化疗栓塞(TACE)后并发肝脓肿的临床特点及易感因素。方法回顾性分析523例肝癌患者共1167次TACE术后并发肝脓肿的发病率、临床表现、治疗转归等临床特点,并分析肝脓肿形成与糖尿病、Child-PughB级肝硬化、门静脉阻塞、胆道梗阻及追加颗粒性栓塞剂栓塞等易感因素的关系。结果 8例患者TACE术后共发生9次肝脓肿。肝脓肿并发症的发病率为0.77%(共1167次操作)。肝脓肿临床表现有肝大、肝区疼痛、发热、白细胞增多,发病时间为术后9～29d,平均(18±9)d。除1例患者由于诊断治疗不及时死亡外,余7例肝脓肿患者经及时诊断和积极经皮肝穿置管引流及抗生素治疗后均痊愈。χ2检验结果显示,具有胆道阻塞易感因素的患者术后肝脓肿的发生率明显高于控制组(χ2=143.848,P<0.001),而糖尿病、门静脉阻塞及追加颗粒性栓塞剂栓塞等易感因素的组间差异无统计学意义(P>0.05)。结论肝癌TACE后肝脓肿并发症具有一定的临床特点,术前胆道梗阻是TACE并发肝脓肿的易感因素。

Objective To determine the clinical characteristic and predisposing factors for liver abscess formation after transcatheter arterial chemoembolization（TACE）of hepatic malignancy.Methods A retrospective study was conducted of 1167 TACE precedures in 523 patients with hepatic malignancy.The incidence,clinical presentation,treatment and prognosis of liver abscess after ATCE were analyzed.The relationship of abscess formation with potential predisposing factors,including diabetes,Child-Pugh class B cirrhosis,portal vein obstruction,biliary obstruction,and additional particle embolization,was also analyzed.Results Nine liver abscesses occurred in 8 patients.The incidence of liver abscess after TACE of hepatic malignancy was 0.77%（9 of 1167 procedures）.The clinical presentation of liver abscess included hepatomegaly,pain,fever and leudocytosis.All abscesses were detected during the 9 to 29 days following TACE（median,18 days±9）.Apart from one case of abscess patient who died because of delayed diagnosis and treatment,7 cases were successfully managed with percutaneous catheter drainage and systemic antibiotics.The incidence of abscess formation after TACE was significantly higher in the patients with earlier biliary obstruction than those without the predisposing factor（χ2=143.848,P0.001）.Conclusions Liver abscess formation after chemoembolization of hepatic malignancy has characteristic clinical features.Biliary obstruction was the predisposing factor of liver abscess formation after TACE.