Zhang Fu-Long, Xu Jing, Jiang Yu-Hong, Zhu Yuan-Dong, Wu Qian-Neng, Shi Yan, Zhu Fang-Yuan, Chen Jing-Wen, Wu Liang-Xiao
Department of Gastroenterology, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China.
Department of Hepatopathy, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China.
World J Clin Cases. 2024 Jun 6;12(16):2911-2916. doi: 10.12998/wjcc.v12.i16.2911.
Transarterial chemoembolization (TACE) is a standard treatment for intermediate-stage hepatocellular carcinoma (HCC). The complications of TACE include biliary tract infection, liver dysfunction, tumor lysis syndrome, biloma, partial intestinal obstruction, cerebral lipiodol embolism, . There are few reports about tracheal fistula induced by TACE.
A 42-year-old man came to our hospital with cough and expectoration for 1 month after TACE for HCC. Laboratory test results showed abnormalities of albumin, hemoglobin, prothrombin time, C-reactive protein, D-dimer, and prothrombin. Culture of both phlegm and liver pus revealed growth of . Computed tomography showed infection in the inferior lobe of the right lung and a low-density lesion with gas in the right liver. Liver ultrasound showed that there was a big hypoechoic liquid lesion without blood flow signal. Drainage for liver abscess by needle puncture under ultrasonic guidance was performed. After 1 month of drainage and anti-infection therapy, the abscess in the liver and the infection in the lung were reduced obviously, and the symptom of expectoration was relieved.
Clinicians should be alert to the possibility of complications of liver abscess and tracheal fistula after TACE for HCC. Drainage for liver abscess by needle puncture under ultrasonic guidance could relieve the liver abscess and tracheal fistula.
经动脉化疗栓塞术(TACE)是中期肝细胞癌(HCC)的标准治疗方法。TACE的并发症包括胆道感染、肝功能障碍、肿瘤溶解综合征、胆汁瘤、部分肠梗阻、脑碘油栓塞等。关于TACE诱发气管瘘的报道较少。
一名42岁男性在接受HCC的TACE治疗1个月后因咳嗽、咳痰来我院就诊。实验室检查结果显示白蛋白、血红蛋白、凝血酶原时间、C反应蛋白、D-二聚体和凝血酶原异常。痰和肝脓肿培养均显示有……生长。计算机断层扫描显示右肺下叶感染,右肝有一个含气的低密度病变。肝脏超声显示有一个大的低回声液性病变,无血流信号。在超声引导下对肝脓肿进行穿刺引流。经过1个月的引流和抗感染治疗,肝脓肿和肺部感染明显减轻,咳痰症状缓解。
临床医生应警惕HCC患者TACE术后发生肝脓肿和气管瘘并发症的可能性。超声引导下经皮穿刺肝脓肿引流可缓解肝脓肿和气管瘘。