肝细胞癌经动脉化疗栓塞术后急性缺血性胆囊炎：发病率及临床结局

Acute ischemic cholecystitis after transarterial chemoembolization of hepatocellular carcinoma: incidence and clinical outcome.

作者信息

Wagnetz Ute, Jaskolka Jeff, Yang Peter, Jhaveri Kartik S

机构信息

Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.

出版信息

J Comput Assist Tomogr. 2010 May-Jun;34(3):348-53. doi: 10.1097/RCT.0b013e3181caaea3.

DOI:10.1097/RCT.0b013e3181caaea3

PMID:20498534

Abstract

PURPOSE

To determine the incidence and clinical outcome of acute ischemic cholecystitis after transarterial chemoembolization (TACE) of hepatocellular carcinoma.

MATERIALS AND METHODS

In this ethics board-approved study, a retrospective review of 355 TACE procedures performed in 246 patients during a 5-year period was performed. The review of postintervention computed tomography (CT) reports for findings indicative of acute cholecystitis identified 12 patients (4.9%). In these patients, all CT scans, laboratory results (white blood cell count, alkaline phosphatase level, total bilirubin level), and clinical reports were analyzed to assess imaging findings and outcomes at the following time points: before TACE, within the first week after the procedure, as well as 1 and 6 months post-TACE.

RESULTS

In 11 of 12 cases, the dominant finding on CT was new gallbladder wall thickening of up to 12 mm, which developed within 24 hours in 10 patients and within the first month after TACE in 1 patient. Gallbladder wall thickening persisted in 1 patient for at least 6 months. Eleven of 12 patients showed deposition of Lipiodol in the gallbladder wall. In 1 patient, the dominant finding on CT was pericholecystic stranding that resolved on follow-up CT after 1 month. None of the patients demonstrated gas in the gallbladder wall, significant pericholecystic fluid, abdominal or liver abscesses. Blood work results revealed transient increase in white blood cell count, alkaline phosphatase level, and total bilirubin level, not different from that seen after TACE in patients without CT evidence of cholecystitis. Clinical reports documented transient right upper quadrant pain for a few days and up to 1 month in 1 case with eventual symptom relief. None of the cases required surgical or radiological intervention. All but 1 case demonstrated normal gallbladder wall thickness after 6 months.

CONCLUSIONS

Acute ischemic cholecystitis is not an uncommon complication after TACE. However, it is self-limiting and does not seem to require any intervention or surgery.

摘要

目的

确定肝细胞癌经动脉化疗栓塞术（TACE）后急性缺血性胆囊炎的发生率及临床结局。

材料与方法

在这项经伦理委员会批准的研究中，对246例患者在5年期间进行的355次TACE手术进行了回顾性分析。通过回顾干预后计算机断层扫描（CT）报告中提示急性胆囊炎的表现，确定了12例患者（4.9%）。对这些患者的所有CT扫描、实验室检查结果（白细胞计数、碱性磷酸酶水平、总胆红素水平）以及临床报告进行分析，以评估在以下时间点的影像学表现和结局：TACE术前、术后第一周内以及TACE术后1个月和6个月。

结果

12例患者中有11例，CT上的主要表现为胆囊壁新出现增厚，最厚达12 mm，10例患者在24小时内出现，1例患者在TACE术后第一个月内出现。1例患者胆囊壁增厚持续至少6个月。12例患者中有11例在胆囊壁可见碘油沉积。1例患者CT上的主要表现为胆囊周围条索状影，1个月后随访CT显示其消散。所有患者胆囊壁均未见气体、明显的胆囊周围积液、腹部或肝脓肿。血液检查结果显示白细胞计数、碱性磷酸酶水平和总胆红素水平短暂升高，与无CT证据提示胆囊炎的TACE患者术后所见无差异。临床报告记录了1例患者出现右上腹短暂疼痛，持续数天至1个月，最终症状缓解。所有病例均无需手术或放射介入治疗。除1例患者外，其余所有患者6个月后胆囊壁厚度均恢复正常。