摘要
目的探讨肝细胞癌(HCC)患者经导管动脉化疗栓塞术(TACE)术后并发胆管损伤的预测因素。方法回顾性研究483例HCC患者TACE术后相关并发症,发现共有21例患者出现TACE术后胆管损伤。记录这类患者TACE术前、术后1周及随访的实验室数据、影像学资料和临床相关病史。分类变量采用χ^(2)检验或Fisher确切概率法;两样本均数的比较采用:配对t检验或wilcoxon秩和检验;多样本均数的比较采用方差分析。结果21例胆管损伤患者分别出现肝内胆管扩张、胆汁瘤及肝门部胆管狭窄等表现。14.3%(3/21)患者TACE术后1周CT平扫出现沿胆管走行区线条样高密度影,76.2%(16/21)患者TACE术后碱性磷酸酶(ALP)>200 U/L,后期随访出现胆管损伤。所有患者TACE术后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、ALP及γ-谷氨酰转移酶(GGT)较术前均明显升高(分别为t=-2.721,P=0.014;t=-2.674,P=0.015;t=-3.079,P=0.006;t=-3.377,P=0.003)。结论TACE术后1周CT平扫胆管周围出现碘油沉积,或ALP(>200 U/L)持续升高,对后期胆管损伤具有一定的预测价值。
Objective To explore the predictive factors of concurrent bile duct injury following transcatheter arterial chemoembolization(TACE)in patients with hepatocellular carcinoma(HCC).Methods A retrospective study was conducted on 483 HCC patients in relation to TACE postoperative complications.A total of 21 cases of bile duct injury were observed following the TACE procedure.Laboratory data,imaging data,and clinically relevant medical histories were recorded before and after one week following the TACE procedure and follow-up.Theχ^(2) test,or Fisher's exact probability method,was used for categorical variables.The mean of the two samples was compared using a paired t-test or Wilcoxon rank sum test.The comparison of multiple mean values was conducted using an analysis of variance.Results Twenty-one cases with bile duct injury had intrahepatic bile duct dilatation,bile tumors,hilar biliary duct stenoses,and other manifestations.14.3%(3/21)of patients showed linear high-density shadows along the bile duct on a plain CT scan,while 76.2%(16/21)of patients had ALP>200 U/L one week following TACE procedure,and bile duct injury occurred in later follow-up.Alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),andγ-glutamyl transferase(GGT)were significantly increased in all patients following TACE procedure(t=-2.721,P=0.014;t=-2.674,P=0.015;t=-3.079,P=0.006;t=-3.377,P=0.003,respectively).Conclusion The deposition of iodized oil around the bile duct on plain CT scan presentation or the continuous increase of ALP(>200 U/L)one week following TACE procedure has a certain predictive value for the later bile duct injury.
作者
徐后云
余细平
王俊丽
胡吉波
胡红杰
Xu Houyun;Yu Xiping;Wang Junli;Hu Jibo;Hu Hongjie(Department of Radiology,the Fourth Affliated Hospital,Zhejiang University School of Medicine,Yiwu 322000,China;Department of Pathology,the Fourth Affiliated Hospital,Zhejiang University School of Medicine,Yiwu 322000,China;Department of Radiology,Sir Run Run Shaw Hospital,Zhejiang University,Hangzhou 310000,China)
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2023年第7期710-715,共6页
Chinese Journal of Hepatology
基金
国家自然科学基金项目(82071988)
浙江省重点研发计划(2019C03064)
浙江省省部共建项目(WKJ-ZJ-1926)
中央高校基本科研业务费专项资金资助(2021FZZX003-02-17、226-2022-00160)
浙江省基础公益研究计划(LGF20H180012)
浙江省教育厅一般项目(Y202248932、Y202249371)
金华市科学技术研究公益类项目(2019-4-129)。
关键词
肝细胞癌
手术后并发症
胆管损伤
经导管动脉化疗栓塞术
Hepatocellular carcinoma
Postoperative complications
Bile ducts injury
Transcatheter arterial chemoembolization
