Cholapranee Aurada, van Houten Diana, Deitrick Ginna, Dagli Mandeep, Sudheendra Deepak, Mondschein Jeffrey I, Soulen Michael C
Division of Interventional Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Cardiovasc Intervent Radiol. 2015 Apr;38(2):397-400. doi: 10.1007/s00270-014-0947-5. Epub 2014 Jul 3.
Patients without a competent sphincter of Oddi due to prior surgical or endoscopic therapy are at high risk for liver abscess following chemoembolization despite aggressive antimicrobial prophylaxis. We examined a cohort of such patients undergoing Y-90 resin radioembolization and compared them to a cohort of chemoembolized patients.
Review of our quality-assurance database identified 24 radioembolizations performed in 16 patients with prior biliary intervention. An aggressive prophylactic regimen of oral levofloxacin and metronidazole 2 days pre-procedure continuing for 14 days after, oral neomycin/erythromycin bowel prep the day before, and IV levofloxacin/metronidazole the day of treatment was prescribed. Patients underwent resin microsphere radioembolization dosed according to the BSA method. Patients had clinical, imaging, and laboratory assessment 1 month after each treatment, and then every 3 months. The chemoembolization cohort consisted of 13 patients with prior biliary intervention who had undergone 24 chemoembolization procedures.
No radioembolization patient developed an abscess. In the cohort of chemoembolized patients who received the same prophylaxis, liver abscess occurred following 3 of 24 (12.5 %) procedures in 3 of 13 (23 %) patients, one fatal.
This preliminary experience suggests that the risk of liver abscess among patients with prior biliary intervention may be lower following radioembolization than chemoembolization, which could potentially expand treatment options in this high-risk population.
由于先前的手术或内镜治疗而导致Oddi括约肌功能不全的患者，尽管进行了积极的抗菌预防，但在化疗栓塞后发生肝脓肿的风险仍然很高。我们研究了一组接受Y-90树脂放射性栓塞的此类患者，并将他们与一组接受化疗栓塞的患者进行了比较。
回顾我们的质量保证数据库，确定了16例先前有胆道干预的患者接受了24次放射性栓塞。制定了积极的预防方案，术前2天口服左氧氟沙星和甲硝唑，并持续至术后14天，术前一天口服新霉素/红霉素进行肠道准备，治疗当天静脉注射左氧氟沙星/甲硝唑。患者根据体表面积法进行树脂微球放射性栓塞治疗。每次治疗后1个月对患者进行临床、影像学和实验室评估，然后每3个月评估一次。化疗栓塞组由13例先前有胆道干预的患者组成，他们接受了24次化疗栓塞治疗。
没有放射性栓塞患者发生脓肿。在接受相同预防措施的化疗栓塞患者队列中，24例（12.5%）治疗中有3例（13例患者中的3例，占23%）发生肝脓肿，其中1例死亡。
这一初步经验表明，先前有胆道干预的患者接受放射性栓塞后发生肝脓肿的风险可能低于化疗栓塞，这可能会扩大这一高危人群的治疗选择。
