Xu H Y, Yu X P, Wang J L, Hu J B, Hu H J
Department of Radiology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China.
Department of Pathology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China.
Zhonghua Gan Zang Bing Za Zhi. 2023 Jul 20;31(7):710-715. doi: 10.3760/cma.j.cn501113-20230607-00249.
To explore the predictive factors of concurrent bile duct injury following transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). A retrospective study was conducted on 483 HCC patients in relation to TACE postoperative complications. A total of 21 cases of bile duct injury were observed following the TACE procedure. Laboratory data, imaging data, and clinically relevant medical histories were recorded before and after one week following the TACE procedure and follow-up. The (2) test, or Fisher's exact probability method, was used for categorical variables. The mean of the two samples was compared using a paired -test or Wilcoxon rank sum test. The comparison of multiple mean values was conducted using an analysis of variance. Twenty-one cases with bile duct injury had intrahepatic bile duct dilatation, bile tumors, hilar biliary duct stenoses, and other manifestations. 14.3% (3/21) of patients showed linear high-density shadows along the bile duct on a plain CT scan, while 76.2% (16/21) of patients had ALP > 200 U/L one week following TACE procedure, and bile duct injury occurred in later follow-up. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and γ-glutamyl transferase (GGT) were significantly increased in all patients following TACE procedure ( = -2.721, = 0.014; = -2.674, = 0.015; = -3.079, = 0.006; = -3.377, = 0.003, respectively). The deposition of iodized oil around the bile duct on plain CT scan presentation or the continuous increase of ALP (> 200 U/L) one week following TACE procedure has a certain predictive value for the later bile duct injury.
探讨肝细胞癌(HCC)患者经动脉化疗栓塞术(TACE)后并发胆管损伤的预测因素。对483例HCC患者TACE术后并发症进行回顾性研究。TACE术后共观察到21例胆管损伤病例。记录TACE术前、术后1周及随访后的实验室数据、影像数据和临床相关病史。分类变量采用卡方检验或Fisher确切概率法。两组样本均值比较采用配对t检验或Wilcoxon秩和检验。多个均值比较采用方差分析。21例胆管损伤患者有肝内胆管扩张、胆管肿物、肝门部胆管狭窄等表现。14.3%(3/21)的患者平扫CT显示沿胆管走行的线状高密度影,76.2%(16/21)的患者TACE术后1周碱性磷酸酶(ALP)>200 U/L,且在后续随访中发生胆管损伤。所有患者TACE术后谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)和γ-谷氨酰转肽酶(GGT)均显著升高(分别为t=-2.721,P=0.014;t=-2.674,P=0.015;t=-3.079,P=0.006;t=-3.377,P=0.003)。平扫CT显示胆管周围碘油沉积或TACE术后1周ALP持续升高(>200 U/L)对后期胆管损伤有一定的预测价值。