Kim Young Woon, Kwon Jung Hyun, Nam Soon Woo, Jang Jeong Won, Jung Hyun Suk, Shin Yu Ri, Park Eun Su, Shim Dong Jae
Department of Internal Medicine, Division of Hepatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon 21431, Republic of Korea.
Department of Internal Medicine, Division of Hepatology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Exp Ther Med. 2018 Feb;15(2):1479-1483. doi: 10.3892/etm.2017.5540. Epub 2017 Nov 22.
Transarterial chemoembolization (TACE) with drug-eluting beads (DC beads) may enhance drug delivery to tumours and reduce systemic toxicity. TACE with DC beads leads to significantly fewer serious side-effects compared with conventional TACE. A 66-year-old man with hepatocellular carcinoma (HCC) complained of continuous abdominal pain 1 month after TACE with DC beads. At the time of TACE, angiography revealed severe stenosis of both hepatic arteries. The diagnostic work up on admission suggested severe bile duct injury with regional bile duct dilatation, segmental liver and spleen infarction, necrotizing pancreatitis, as well as gastric and duodenal ulcers. The pathology specimens of the duodenum contained DC beads that had passed through small vessels in the connective tissue. The patient's condition appeared to improve after 2 weeks of antibiotic treatment and supportive care, but new multifocal liver and spleen infarction subsequently developed. After 2 months, he was well enough to be discharged. His HCC partially responded to the TACE with DC beads but eventually progressed and he died after 11 months. The present case report highlights unexpected ongoing multiple organ ischaemia in a 66-year-old man treated for HCC using TACE with DC beads. The use of TACE with DC beads should be carefully considered in patients with vascular strictures or aberrant blood supply.
经动脉化疗栓塞术（TACE）联合载药微球（DC微球）可增强药物向肿瘤的递送并降低全身毒性。与传统TACE相比，TACE联合DC微球导致的严重副作用明显更少。一名66岁的肝细胞癌（HCC）男性患者在接受TACE联合DC微球治疗1个月后出现持续性腹痛。在TACE时，血管造影显示双侧肝动脉严重狭窄。入院时的诊断检查提示严重胆管损伤伴局部胆管扩张、节段性肝脾梗死、坏死性胰腺炎以及胃和十二指肠溃疡。十二指肠病理标本中含有通过结缔组织中小血管的DC微球。经过2周的抗生素治疗和支持治疗后，患者病情似乎有所改善，但随后出现了新的多灶性肝脾梗死。2个月后，他康复出院。他的HCC对TACE联合DC微球治疗部分缓解，但最终病情进展，11个月后死亡。本病例报告强调了一名66岁接受TACE联合DC微球治疗HCC的男性患者出现意外的持续性多器官缺血。对于有血管狭窄或异常血供的患者，应谨慎考虑使用TACE联合DC微球。
