肝癌消融术后胆道并发症65例患者超声特征及临床转归

Biliary complications after percutaneous ablation for patients with hepatic malignant tumors：retro-spective analysis of ultrasonic imaging features and clinical outcomes

目的：回顾性分析肝脏恶性肿瘤经皮超声引导下消融术后胆道并发症的超声特征和临床转归。方法收集2007年5月至2014年11月我院采用经皮超声引导下消融治疗肝癌并出现胆道并发症患者的相关临床资料，分析术后胆道并发症的超声特征和临床转归。结果65例患者消融术后出现胆道并发症，其中胆管扩张34例（34／65，52.3％），胆汁瘤31例（31／65，47.7％）。患者消融术后肝内胆管扩张均位于消融灶远端，有随访资料的患者共30例，9例出现进展（9／30，30.0％），1例好转（1／30，3.3％），20例（20／30，66.7％）保持稳定。胆汁瘤影像学表现为新月型13例（13／31，41.9％）、弥散型13例（13／31，41.9％）、环状型3例（3／31，9.7％）、孤立结节型2例（2／31，6.5％）。胆汁瘤自发消失、好转、保持稳定及进展的例数分别为3例（3／25，12％）、3例（3／25，12％）、17例（17／25，68％）、2例（2／25，8％）。6例患者在胆汁瘤出现后行手术或介入治疗，没有因胆汁瘤而死亡的病例。结论肝癌消融术后患者胆道并发症主要为胆汁瘤和胆管扩张。胆汁瘤的影像学形态最常见的是新月型和弥散型，胆管扩张均位于消融灶远端；经皮超声引导下肝癌消融术后胆道并发症多可好转或保持稳定，必要时需予以手术或介入治疗。

Objective To retrospectively analyze the ultrasonic imaging features and clinical out-comes of biliary complications after percutaneous ablation for hepatic malignant tumors .Methods The cli-nical data of patients with postablation biliary complications who underwent percutaneous ablation for hepatic malignant tumors in the past 7 years in our department were retrospectively analyzed .The ultrasonic imaging features and the clinical outcomes of biliary complications on follow-up of these patients were analyzed .Re-sults Postablation biliary complications occurred in 65 patients , including 34 patients with bile duct dilata-tion and 31 patients with biloma .In patients with bile duct dilatation , the dilated bile ducts were located dis-tal to the ablation lesions in all these patients .Among 30 patients with bile duct dilatation , the dilatation was progressive in 9 patients （9/30, 30.0%） and stable in 20 patients （20/30, 66.7%）, while in one patient （1/30, 3.3%） it resolved on follow-up.The radiologic features of bilomas mainly manifested as four types：crescent , interspersed , circumferential and solitary nodular , and the number of patients with the four types were 13 （13/31, 41.9%）, 13（13/31, 41.9%）, 3（3/31, 9.7%） and 2（2/31, 6.5%）, respectively. In 6 patients （6/31, 19.4%） the bilomas were subjected to interventional or surgical therapy while for the remaining 25 patients （6/31, 19.4%） they were treated conservatively .Three （3/25, 12.0%） of the lat-ter 25 patients had spontaneously disappearance of the biloma and 2 （2/25, 8.0%） of the remaining 22 pa-tients appeared to have progressive increase in size .In 17 （17/25, 68.0%） patients the biloma remained stable in size and in the remaining 3 patients （3/25, 12.0%） the bilomas resolved.Conclusions Postab-lation biliary complications of ultrasound-guided percutaneous ablation for hepatic malignant tumors mainly presented as biloma and bile duct dilatation .Dilated bile ducts were located in the distal side of the ablation zones.Crescent type and interspersed type were the most common morphological types of biloma .Although most patients with postablation biliary complications of ultrasound-guided percutaneous ablation remained sta-ble or resolved on follow-up, interventional or surgical therapy was necessary in the minority of patients .