药物洗脱微球栓塞治疗肝细胞肝癌中血管湖的临床处理

Drug-Eluting Beads Chemoembolization in the Treatment of Hepatocellular Carcinoma: The Management of Vascular Lake Phenomenon

目的探索血管湖在药物洗脱微球(DEBs)栓塞治疗肝细胞肝癌过程中的发生率及临床治疗措施,结合文献分析其产生原因及临床意义。方法回顾性分析使用药物洗脱微球栓塞治疗75例肝细胞肝癌患者资料。75例患者均为首诊并使用DEBs栓塞治疗。统计在第一次栓塞治疗中出现血管湖的次数及临床处理方法。结果手术成功率为100%。共计治疗141个病灶结节,发现23个血管湖,按病灶结节计算发现率为16. 3%(23/141)。23个血管湖分为稳定型12个,不稳定型11个。不稳定型血管湖均使用栓塞剂进一步栓塞。随访中2例合并稳定型血管湖者发现局部肿瘤残留,予以CT导向下射频消融治疗;1例不稳定型血管湖者发生肝破裂出血并死亡。结论血管湖为DEBs治疗中的独特现象,可以合并肿瘤残留及破裂出血风险,需要谨慎处理。

Objective To evaluate the incidence rate and clinical management of vascular lake(VL)phenomenon during chemoembolization with drug-eluting beads(DEBs)in treatment of hepatocellular carcinoma(HCC).The causes and clinical significance were analyzed in combination with literature.Methods This retrospective study recruited 75 patients with HCC who were treated with DEBs.All patients were first diagnosed and treated with DEBs.The frequency and management of VL during the first embolization would be recorded.Results 75 cases were all successful.A total of 141 nodules were treated,and 23 VLs were found.The incidence rate was 16.3%(23/141).In addition,the 23 VLs were divided into 12 stable types and 11 unstable types.All the unstable VLs were further embolized with embolization agents.During the follow-up,2 stable VLs were found with local tumor residues,which were treated with CT-guided radiofrequency ablation.Liver rupture with hemorrhage occurred in 1 unstable LV patient with subsequent death.Conclusion Vascular lake,a unique phenomenon occurred in chemoembolization with DEBs,combined with residual tumor has the risk of of liver rupture bleeding,which should be managed carefully.