摘要
目的探讨肝癌患者肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）引起胆管损伤的危险因素以及预测。方法回顾性分析483例经TACE治疗后21例发生胆管损伤患者的临床资料，分析胆管损伤发生的可能因素及临床转归。结果该21例患者中16例在TACE前有肝切除手术史。本组TACE术后出现胆管损伤时间1-12个月，平均（3．9±2．7）个月，其中3例出现肝内胆管扩张、胆汁瘤及肝门部胆管狭窄，3例肝门部胆管狭窄合并肝内胆管扩张，5例胆汁瘤合并肝内胆管扩张，9例肝内胆管扩张，1例胆汁瘤。TACE术后丙氨酸转氨酶、天冬氨酸转氨酶、碱性磷酸酶及谷氨酰转肽酶较术前均明显升高，差异有统计学意义（分别为t=-2．721，-2．674，-3．079，-3．377，均P〈0．05）。结论TACE术后胆管损伤与碘油、PVA、明胶海绵颗粒堵塞胆管动脉血供有关。肝脏手术史是TACE术后胆管损伤的危险因素。
Objective -To evaluate the risk factors of bile duct injury after transcatheter arterial chemoembolization （TACE） for hepatic carcinoma （HCC）. Methods Retrospective analysis was made on 21 patients complicating bile duct injury among 483 cases undergoing TACE for HCC. Results 21 patients were found to suffer from bile duct injury, the average interval between bile duct injury and TACE was 3. 9 ±2. 7 months （9 cases of intrahepatic bile ducts dilation, 1 case of biloma, 3 cases of hepatic bile duct stricture combined with intrahepatic bile ducts dilation, 5 cases of biloma combined with intrahepatic bile ducts dilation, 3 cases with a triplex of intrahepatic bile ducts dilation, biloma and intrahepatic bile ducts dilation ）. Bile duct injury was accompanied by elevation of alanine aminotransferase （ALT）, aspertate aminotransferase （AST）, alkaline phosphatase （ALP）and gamma glutamyl transpeptidase （GGT） （respectively t = - 2. 721, - 2. 674, - 3. 079, - 3. 377, all P 〈 0.05）. Among those 21 patients TACE was given after hepatectomy in 16 cases. Conclusions Bile duct injury complicating TACE has a causal relationship with intraarterial embolism of the hepatic artery branches . Pre-TACE hepatectomy was a risk factor for TACE related bile duct injury.
出处
《中华普通外科杂志》
CSCD
北大核心
2016年第11期917-920,共4页
Chinese Journal of General Surgery
基金
浙江省重大科技专项重点社会发展项目（2011C13038）
浙江省卫生适宜技术成果转化计划（B类）（2011ZHB004）
关键词
癌
肝细胞
手术后并发症
胆管
肝动脉化疗栓塞术
Carcinoma, hepatocellular
Postoperative complications
Injuries, bile ducts
Transcatheter arterial chemoembolization
