肝动脉栓塞化疗后肝内胆道并发症(附108例分析)

COMPLICATIONS OF BILIARY TRACT AFTER HEPATIC ARTERY CHEMOEMBOLIZATION

目的 探讨肝动脉栓塞化疗引起肝脏胆道并发症的临床表现、病理改变、发病机理及预防治疗的方法。方法 观察 1990年 6月至 1999年 6月收治 10 8例经过 1～ 6次肝动脉栓塞化疗患者治疗结果。结果 肝动脉栓塞化疗 4次以上者 3 5例 ,发现胆道病变 6例 ,发生率为 17.14 % ;化疗 3次以下者 73例 ,发生 2例 ,为 2 .4 7% ,显著低于前者。结论 发生机理可能主要是因为胆管的营养血管多次被栓塞而没有及时建立起有效的侧支循环 ,胆管缺血 ,管壁发生无菌性炎性增生 ,上级胆管扩张、胆汁淤积、胆石形成。预防治疗措施包括延长治疗间隔时间、辅助其他治疗 ,积极防治原发胆道病变及改善肝胆内循环。

Objectives To study the clinical phenmenon,pathologic change,mechanism,prevention and treatment of the biliary disease caused by the transcatherter arterial chemoembolizaton(TACE). Methods To observe 108 patients who undtrnent TACE during 1990.6 to 1999.6. Results Anong 35 patients with TACE for 4 or more times, pathological changes in biliary tract was found in 6 cases.The incidence rate was 17.14%.only two patients had the bileduct disease among the other 73 patients with TACE for 3 or less times,the incidence rate was 2.47%,lower than the former statistically. Conclusions The major mechanism of the complication in biliary tract caused by TACES may be the embolism of the nutruitious blood vessels of biliary tract caused by and the poorreconstruction of collateral circulation .The ischemia of biliary tract may cause non-bacterial inflammation and proliferation;Biliary tract changes include:introhepatic cholestasis and the formation of cholelithiasis.The preventment and treatment may include:prolongation of the interval time between two twice TACE;assistance with other treatment,such as radiotherapy and Chinese medicine,treatment of primary pathological disease and the improvement of circulation ofliver and biliary tract.