Miyayama Shiro, Yamashiro Masashi, Nagai Keiichi, Yokka Akira, Yoshida Miki, Sakuragawa Naoko, Sanada Taku, Notsumata Kazuo
Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan.
Department of Internal Medicine, Fukuiken Saiseikai Hospital, Fukui, Japan.
Hepatol Res. 2017 Dec;47(13):1390-1396. doi: 10.1111/hepr.12880. Epub 2017 Apr 24.
To evaluate the incidence and condition of necrotic tumor excretion into the biliary system in patients with hepatocellular carcinoma (HCC) >5 cm treated with conventional transcatheter arterial chemoembolization (TACE).
Eighty-three patients who underwent TACE for newly developed HCC >5 cm without an intraductal tumor thrombus and were followed-up by computed tomography for longer than 6 months were eligible. According to the location, the maximum tumors were divided into central (in contact with the left or right hepatic duct, n = 39) or peripheral (not in contact with them, n = 44). When high-density material in the biliary system that was not seen on pretreatment computed tomography was identified, it was determined as excreted necrotic tumor tissue containing iodized oil. The incidence, interval between TACE and occurrence of the necrotic tumor excretion, and clinical course were evaluated.
Tumor excretion into the biliary system was identified in nine (10.8%) patients with a central tumor (mean diameter, 85.0 ± 29.6 mm) 28-433 days (mean, 219.3 ± 128.2) after the initial TACE. In one patient, the necrotic tumor cast caused cholangitis 1203 days after the initial TACE, and was endoscopically removed. Infection of the embolized tumor developed in two cases and percutaneous drainage was carried out 105 and 158 days later, respectively.
Excretion of necrotic tumors into the biliary system after TACE was not rare in patients with centrally located HCC >5 cm. The detached tumor rarely caused symptoms and the communication between the tumor and bile duct caused the infection of tumors.
评估接受传统经导管动脉化疗栓塞术（TACE）治疗的直径>5 cm肝细胞癌（HCC）患者中，坏死肿瘤排入胆道系统的发生率及情况。
83例因新发生的直径>5 cm HCC且无导管内肿瘤血栓而接受TACE治疗并经计算机断层扫描随访超过6个月的患者符合研究条件。根据肿瘤位置，将最大肿瘤分为中央型（与左或右肝管接触，n = 39）或周围型（不与左或右肝管接触，n = 44）。当在胆道系统中发现预处理计算机断层扫描未见的高密度物质时，将其确定为含有碘油的坏死肿瘤组织排出。评估坏死肿瘤排出的发生率、TACE与坏死肿瘤排出发生之间的间隔以及临床病程。
在9例（10.8%）中央型肿瘤（平均直径85.0±29.6 mm）患者中，在初次TACE后28 - 433天（平均219.3±128.2天）发现肿瘤排入胆道系统。1例患者在初次TACE后1203天坏死肿瘤铸型引起胆管炎，并在内镜下取出。2例发生栓塞肿瘤感染，分别在105天和158天后进行经皮引流。
TACE后，直径>5 cm中央型HCC患者中坏死肿瘤排入胆道系统并不罕见。脱落的肿瘤很少引起症状，肿瘤与胆管之间的连通导致肿瘤感染。
