肝肿瘤经肝动脉化疗栓塞术后并发肝脓肿的原因与治疗

Study on the causes and treatment of liver abscess after transcatheter arterial chemoembolization for liver tumor

目的：分析肝肿瘤经肝动脉化疗栓塞术后并发肝脓肿的原因，总结其治疗方法。方法收集2012年6月-2014年6月在我院因肝肿瘤行 TACE 治疗后发生肝脓肿患者6例，其中男性5例，女性1例，年龄38-65岁，其中原发性肝癌4例，肝转移瘤1例，肝血管瘤1例。结果5例肝脓肿患者经穿刺引流及积极抗炎对症处理后，症状均明显改善，脓腔缩小或消失，充分引流后痊愈；另外1例症状反复，经检查伴发腹腔脓肿，积极对症处理无明显改善，后死于严重感染和多脏器功能衰竭。结论 TACE 后并发肝脓肿发病率低，但后果严重，认识其发病机制，提高诊断意识，及时足量应用敏感抗生素，积极进行脓腔穿刺抽吸、引流，是肝脓肿有效的治疗方法。尤其对于肿瘤体积大、病变靠近胆囊、伴门脉癌栓、伴2型胆管异常的肝肿瘤患者，行 TACE 治疗时一定要慎重，避免肝脓肿的发生。

Objective To study the causes and treatment of liver abscess after transcatheter arterial chemoembolization for liver tumor .Methods From Jun ,2012 to Jun ,2014 ,6 patients developed liver abscess after TACE in which 5 were male ,and one was female ,aged 38 - 65 .4 cases of them were primary HCC ,one of them was liver metastasis ,and anoth‐er one was hepatic hemangioma .Results The clinical symptoms of liver abscess in 5 patients were obviously improved af‐ter percutaneous drainage and after using antibiotics .1 case with severe abdominal abscesses died of severe infection and multiple organ failure .Conclusion Thouroughly understanding the pathogenesis and imaging features of liver abscess after TACE for liver tumor is very important in prevention ,early diagnoses and treatment .The effective therapeutic measures in dealing with liver abscess include combining percutaneous drainage and use of sensitive antibiotics .For patients with large hepatic tumor ,those liver tumor adjacent to the gallbladder ,those with portal vein embolus ,and those patients who had undergone Whipple or other surgical treatment ,the possibility of developing liver abscess should be given special care .