Wang Mao-qiang, Shao Ru-hong, Ye Hui-yi, Wang Zhi-qiang, Wang Zhong-pu, Liu Feng-yong
Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Zhong Liu Za Zhi. 2005 Oct;27(10):609-12.
To investigate the image findings of bile duct injury after transcatheter arterial chemoembolization (TACE) for hepatic malignancy.
During the past 3 years, 1240 patients with different hepatic malignancies had undergone a total of 2680 TACE procedures. Eighteen patients (1.4%) developed bile duct injuries from 3 weeks to 3 months after TACE. All of the 18 patients received follow-up CT and ultra-sonography, 14 MRI and 15 digital subtract angiography (DSA). The image data was retrospectively reviewed, with the potential predisposing factors correlated to TACE-induced bile duct injury.
TACE-induced bile duct injuries developed in 13 of 148 patients with liver metastasis (8.8%), 5 of 1092 patients with hepatocellular carcinoma (HCC) (0.5%). On image examination, focal peripheral intrahepatic bile duct dilatation was detected in 4 cases, multiple bile duct dilatations with segmental or sub-segmental distribution in 8, and a large lobular cystic lesion or biloma in 6 cases, and progressive atrophy of the corresponding hepatic parenchyma in 6 patients in whom the TACE induced-bile injury developed at different intervals after TACE. The incidence of bile duct injury was higher in non-cirrhotic patients with metastatic liver lesions than in patients with hepatocellular carcinoma associated with cirrhosis (P < 0.01), and it was also higher in patients using an emulsion of lipiodol-cisplatin or carboplatin than in patients using other emboliging agents (P < 0.01). The incidence was higher either in patients with hypovascular lesions than in patients with hypervascular lesions (P < 0.05).
Biliary abnormalities, including focal and multiple intrahepatic bile duct dilatation, and cystic lesion or biloma, may develop and can be detected during the follow-up examination imaging in patients with hepatic malignancy after TACE. Noncirrhotic liver and intact function, due to the lack of peri-biliany collateral circulation, are the significant predisposing factors to the development of TACE-induced bile duct injury.
探讨肝恶性肿瘤经动脉化疗栓塞术（TACE）后胆管损伤的影像表现。
在过去3年中，1240例不同肝恶性肿瘤患者共接受了2680次TACE手术。18例患者（1.4%）在TACE术后3周~3个月发生胆管损伤。18例患者均接受了CT和超声随访检查，14例接受了MRI检查，15例接受了数字减影血管造影（DSA）检查。对影像资料进行回顾性分析，并分析与TACE所致胆管损伤相关的潜在危险因素。
肝转移瘤148例中有13例（8.8%）发生TACE所致胆管损伤，肝细胞癌（HCC）1092例中有5例（0.5%）发生。影像检查发现，4例出现肝内局限性周边胆管扩张，8例出现节段性或亚节段性分布的多发胆管扩张，6例出现大叶性囊性病变或胆汁瘤，6例在TACE术后不同时间发生TACE所致胆管损伤的患者出现相应肝实质进行性萎缩。非肝硬化肝转移患者胆管损伤的发生率高于肝硬化合并肝细胞癌患者（P<0.01），使用碘油-顺铂或卡铂乳剂的患者高于使用其他栓塞剂的患者（P<0.01）。乏血供病变患者的发生率高于富血供病变患者（P<0.05）。
肝恶性肿瘤患者TACE术后随访检查影像中可出现包括局限性和多发性肝内胆管扩张、囊性病变或胆汁瘤在内的胆道异常表现。非肝硬化肝脏及功能正常，因缺乏胆管周围侧支循环，是TACE所致胆管损伤发生的重要危险因素。
