肝肿瘤消融相关胆道出血的临床表现及治疗

Clinical features and treatment of hemobilia associated with liver tumor ablation therapy

目的探讨肝肿瘤消融所致胆道出血的临床表现及治疗情况。方法回顾性分析8例肝肿瘤消融术后胆道出血患者,1例接受内科保守治疗,对4例患者行动脉栓塞治疗,3例行动脉栓塞＋胆囊穿刺引流治疗。结果肝肿瘤消融术后8例胆道出血患者均无休克表现,均有腹痛,黑便7例,术中呕血2例;血红蛋白较术前下降6~62g/L（中位值18.0g/L）。4例胆红素明显升高（正常水平4倍以上）。对3例行血/尿淀粉酶检查的患者中,2例血/尿淀粉酶升高。8例患者CT图像上均见胆囊内液性高密度影。7例接受动脉造影的患者中,2例见假性动脉瘤。治疗后随访1~3个月,8例患者均恢复良好,无死亡病例。结论胆道出血是肝癌消融治疗的少见并发症,根据临床表现、实验室及影像学检查可及早做出诊断。对于出血量大或保守治疗无效的患者应及早考虑动脉栓塞,对于胆红素明显升高的患者可联合胆道引流。

Objective To explore the clinical features and treatment of hemobilia associated with liver tumor ablation therapy.Methods Eight patients with hemobilia after liver tumor ablation were retrospectively analyzed.One patient was treated with conservative treatment,four patients underwent arterial embolization,and three cases underwent arterial embolization plus gallbladder drainage.Results In 8 patients,no shock were observed,and all patients had abdominal pain,7 cases were of melena,2 cases had intraoperative hematemesis.Hemoglobin decreased 6—62g/L（median 18.0g/L）compared with that in preoperation.Blood bilirubin was significantly higher（more than 4 times of the normal level）in 4 cases.Two of 3 patients underwent blood and urine amylase examination showed blood and urine amylase ascension.CT in all eight patients showed gallbladder high density liquid.Seven patients underwent angiography,and two cases were observed with pseudoaneurysm.After 1—3 months follow-up,all patients recovered well after treatment,without death cases.Conclusion Hemobilia is a rare complication of liver cancer ablation therapy.The diagnosis can be made in early stage based on clinical manifestations,laboratory examination and imaging findings.For the cases with severe bleeding or conservative treatment failing,arterial embolization should be considered.For patients with significantly elevated blood bilirubin,biliary drainage can be considered.