论文部分内容阅读
目的观察经导管肝动脉化疗栓塞术(TACE)治疗肝脏恶性肿瘤后继发胆管损伤的影像学表现。方法1240例患者行TACE2680次,18例于TACE术后3周~3个月出现胆管损伤。18例TACE前后均行CT和超声波检查,14例行MRI,15例行血管造影。对18例不同类型的肝脏恶性肿瘤TACE术后胆管损伤的发生率、影像学表现及导致胆管损伤的高危因素进行回顾性分析。结果肝转移性肿瘤TACE术后胆管损伤的发生率为8.8%(13/148),肝细胞性肝癌(HCC)胆管损伤的发生率为0.5%(5/1092)。影像学表现为局灶性胆管扩张4例,多灶性肝段-亚段胆管扩张8例,巨大囊性病灶或胆汁瘤6例。胆管损伤区肝叶-段呈进行性萎缩6例。分析结果显示,TACE术后胆管损伤多发生于无肝硬变者的肝转移瘤患者(P<0.01);同时,使用铂类制剂与碘油乳化行TACE以及肿瘤为少血供型(P均<0.01),也是高危因素。结论TACE后可出现局灶性、多灶性胆管扩张和胆汁瘤等胆管损伤表现;无肝硬变者是TACE后造成胆管损伤的主要危险因素。
Objective To observe the imaging findings of secondary bile duct injury after transcatheter hepatic arterial chemoembolization (TACE) for the treatment of hepatic malignancies. Methods 1240 patients underwent TACE 2680 times, 18 cases of TACE in 3 weeks to 3 months after bile duct injury. 18 cases of TACE before and after CT and ultrasound examination, 14 cases of MRI, 15 cases of angiography. The incidence of bile duct injury, imaging findings and the risk factors of bile duct injury in 18 different types of hepatic malignancies after TACE were analyzed retrospectively. Results The incidence of bile duct injury after hepatic metastasis was 8.8% (13/148) after TACE and 0.5% (5/1092) after hepatocellular carcinoma (HCC). Imaging findings of focal ductal dilatation in 4 cases, multifocal liver segment - subhepatic bile duct dilatation in 8 cases, giant cystic lesions or bile tumor in 6 cases. 6 cases of progressive atrophy of the hepatic lobe segment of bile duct injury area. The results of the analysis showed that bile duct injury occurred mostly in patients with liver metastases without hepatocirrhosis after TACE (P <0.01). At the same time, the use of platinum preparations and lipiodol emulsified TACE and the tumor was less blood supply (P <0.01), but also a high risk factor. Conclusion TACE may present with focal, multifocal bile duct dilatation and bile duct injury and other bile duct injury manifestations. Patients without cirrhosis are the major risk factors of bile duct injury after TACE.