Ozçinar Beyza, Güven Koray, Poyanli Arzu, Ozden Ilgin
Department of General Surgery, Istanbul University School of Medicine, Istanbul, Turkey.
Diagn Interv Radiol. 2009 Mar;15(1):36-8.
A patient who developed necrotizing pancreatitis after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) is presented. A 55- year-old man had been followed for chronic hepatitis B infection for 10 years at another institution. He presented with multiple masses in the right lobe of the liver and a metastasis in the left adrenal gland. He was referred after a percutaneous liver biopsy which revealed a moderately differentiated HCC. He was treated by TACE. At the third session of TACE, the right hepatic artery was found to be thrombosed; however, angiography also demonstrated collateral feeder vessels (arising from the pancreaticoduodenal artery) which were used for treatment. He developed necrotizing pancreatitis, possibly due to regurgitation of the chemotherapeutic agents to the pancreas. He recovered without complications with imipenem-cilastatin prophylaxis. Acute pancreatitis is a rare but severe complication of TACE. Selective catheterization of the tumor vessels is the established standard in TACE. A careful risk-benefit analysis is mandatory in patients with abnormal collateral vessels. Treatment of acute necrotizing pancreatitis (ANP) after TACE is the same as the accepted approach to ANP due to other causes.
本文报告了一例因肝细胞癌（HCC）行经导管动脉化疗栓塞术（TACE）后发生坏死性胰腺炎的患者。一名55岁男性在另一机构因慢性乙型肝炎感染接受了10年的随访。他因肝右叶多发肿块及左肾上腺转移就诊。经皮肝穿刺活检显示为中度分化的HCC后，他接受了TACE治疗。在第三次TACE治疗时，发现右肝动脉血栓形成；然而，血管造影也显示了（发自胰十二指肠动脉的）侧支供血血管，这些血管被用于治疗。他发生了坏死性胰腺炎，可能是由于化疗药物反流至胰腺所致。通过亚胺培南 - 西司他丁预防性治疗，他康复且未出现并发症。急性胰腺炎是TACE罕见但严重的并发症。肿瘤血管的选择性插管是TACE既定的标准。对于有异常侧支血管的患者，必须进行仔细的风险效益分析。TACE后急性坏死性胰腺炎（ANP）的治疗与其他原因导致的ANP的公认治疗方法相同。
