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目的探讨肝癌经导管动脉化疗栓塞(TACE)术后胆汁瘤形成的原因及治疗策略。方法分析1 840例行TACE治疗患者的数字减影血管造影(DSA)及临床资料,采用Seldinger技术经股动脉插管,常规行腹腔动脉、肠系膜上动脉造影,根据造影结果,制定TACE方案,使栓塞剂充分充填肿瘤病灶。结果 15例(0.82%)患者出现胆汁瘤,其中原发性肝癌3例,转移性肝癌12例;6例经单纯B超引导下穿刺抽出胆汁后治愈,其余9例在B超引导下穿刺抽出胆汁后复发,7例复发患者经放置引流管引流(12～23 d)治愈,2例经放置引流管引流25 d后仍有一定量的胆汁引流出,经DSA证实胆汁瘤未与肝内胆管相通,注射无水乙醇硬化治疗后治愈。结论 TACE术后出现胆汁瘤可在B超或CT引导下穿刺抽出胆汁,如果胆汁瘤复发,则应放置引流管引流或在排除胆汁瘤与肝内胆管相通的情况下,应用无水乙醇消融治疗。
Objective To investigate the causes and treatment strategies of bile tumor after transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma. Methods The digital subtraction angiography (DSA) and clinical data of 1840 patients underwent TACE were analyzed. The Seldinger technique was used for femoral artery catheterization and conventional celiac artery and superior mesenteric artery angiography. TACE protocol Embolization agent full of tumor lesions. Results Bile tumors were found in 15 patients (0.82%), of which 3 were primary hepatocellular carcinoma and 12 were metastatic hepatocellular carcinoma. Six patients underwent B-ultrasound guided bile extraction and the other 9 patients underwent needle biopsy After bile recurrence, 7 cases of recurrent patients were treated with drainage tube drainage (12 ~ 23 days), 2 cases were still drainage after a drainage tube was placed for 25 days, and confirmed by DSA that the bile tumor did not communicate with the intrahepatic bile duct , After injection of ethanol sclerosis cured. Conclusion Bile tumors may occur after TACE. The bile may be punctured under the guidance of B-ultrasound or CT. If the bile tumor recurred, the drainage tube should be placed for drainage or the ablation of bile tumor and intrahepatic bile duct should be performed with absolute ethanol ablation .