Wang Qi, Hodavance Michael, Ronald James, Suhocki Paul V, Kim Charles Y
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People's Republic of China.
Division of Vascular and Interventional Radiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA.
Cardiovasc Intervent Radiol. 2018 Sep;41(9):1391-1398. doi: 10.1007/s00270-018-1989-x. Epub 2018 May 24.
To assess the incidence of biliary complications, cholecystitis, and abscess formation in HCC patients following transarterial embolization (TAE) using particles mixed with concentrated antibiotics.
Retrospective review of HCC patients treated with embolization over a 10-year period revealed 499 procedures in 257 patients. TAE was performed with particles mixed with concentrated antibiotics in addition to IV antibiotics. All follow-up imaging after treatment was retrospectively reviewed for the development of bilomas, biliary strictures, acute cholecystitis, and hepatic abscess. Clinical notes and laboratory tests were also reviewed.
Mean follow-up duration was 18.2 months. In total, there was one biliary complication consisting of biloma formation. This patient had subsegmental hepatic infarction identified on imaging 8 days post-embolization in the setting of subsegmental portal vein thrombus, with subsequent biloma development. There were no cases of new biliary strictures in the embolized portion of the liver at any point after treatment. One patient developed acute gangrenous cholecystitis 10 days post-procedure. No patients developed a hepatic abscess, although 10 patients had bilioenteric anastomoses or incompetent sphincters of Oddi.
Biliary complications and cholecystitis occurred extremely rarely after TAE, at a markedly lower rate than historical data on TACE. Despite significant risk factors for abscess formation in 10 patients, TAE with particles mixed with concentrated antibiotics resulted in zero abscesses, in contrast to a very high rate after TACE in the literature.
评估使用与浓缩抗生素混合的微粒进行经动脉栓塞术（TAE）后肝癌患者发生胆道并发症、胆囊炎及脓肿形成的发生率。
对10年间接受栓塞治疗的肝癌患者进行回顾性研究，共纳入257例患者的499次手术。除静脉使用抗生素外，TAE采用与浓缩抗生素混合的微粒进行。对治疗后的所有随访影像进行回顾性分析，以观察胆汁瘤、胆道狭窄、急性胆囊炎及肝脓肿的发生情况。同时回顾临床记录和实验室检查结果。
平均随访时间为18.2个月。总共有1例胆道并发症，表现为胆汁瘤形成。该患者在栓塞术后8天影像检查发现亚段肝梗死，合并亚段门静脉血栓形成，随后出现胆汁瘤。治疗后任何时间，肝栓塞部位均未出现新的胆道狭窄病例。1例患者术后10天发生急性坏疽性胆囊炎。尽管10例患者存在胆肠吻合或Oddi括约肌功能不全，但无患者发生肝脓肿。
TAE术后胆道并发症和胆囊炎的发生率极低，明显低于经动脉化疗栓塞术（TACE）的历史数据。尽管10例患者存在形成脓肿的显著危险因素，但与文献中TACE术后极高的脓肿发生率相比，使用与浓缩抗生素混合的微粒进行TAE术后脓肿发生率为零。
