专题研究(Monographic Study)

肝细胞癌患者介入手术后胆汁瘤发病因素与临床特点

Published at: 2016年第25卷第7期

刘昭明 1 , 李祯 2 , 许丙辉 1 , 刘洋 3 , 齐双玉 1 , 郑少华 1 , 李恒力 1
1 河北省衡水市哈励逊国际和平医院肝胆外科, 河北 衡水 053000
2 河北省衡水市哈励逊国际和平医院介入科 , 河北 衡水 053000
3 河北省衡水市哈励逊国际和平医院超声科, 河北 衡水 053000
通讯作者 昭明 刘 Email: shaoming678@sina.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.07.007
基金:

摘要

目的:探讨肝细胞癌患者介入手术后胆汁瘤发病因素与临床特点。方法:回顾性分析2013年1月—2015年1月期间500例经肝动脉化疗栓塞介入手术(TACE)治疗的肝细胞癌患者的临床资料,分析患者手术后胆汁瘤发病的危险因素和临床表现。结果:500例患者中45例(9.0%)术后发生胆汁瘤。统计分析显示,存在胆道扩张、TACE术前肝切除史、非超选择性插管、使用聚乙烯醇(PVA)颗粒是患者介入手术后发生胆汁瘤的危险因素(均P<0.05)。45例胆汁瘤患者中10例为有症状胆汁瘤患者,主要为黄疸和发热,且胆汁瘤直径明显高于无症状患者(8.12 mm vs. 21.84 mm,P<0.05),穿刺引流治疗后8例患者胆汁瘤缩小,2例消失;35例无症状组患者定期影像学随访。结论:对于有危险因素的肝细胞癌患者,应积极做术前好评估和预防工作。有症状的胆汁瘤患者应当进行穿刺置管引流治疗,无症状的胆汁瘤患者应当进行影像学随访,若胆汁瘤增大需要进行穿刺置管引流治疗,均能取得良好的预后。


Pathogenic factors and clinical features of biloma in hepatocellular carcinoma patients after interventional therapy

Abstract

Objective: To investigate the causal factors and clinical features of biloma in hepatocellular carcinoma (HCC) patients following interventional procedures. Methods: The clinical data of 500 HCC patients undergoing transcatheter arterial chemoembolisation (TACE) from January 2013 to January 2015 were reviewed. The risk factors for occurrence of postoperative biloma and its clinical features were analyzed. Results: Biloma occurred in 45 (9.0%) of the 500 patients after operation. Results of statistical analysis identified that presence of bile duct dilatation, history of liver resection before TACE, non-superselective intubation and use of polyvinyl alcohol (PVA) particles were risk factors for biloma (all P<0.05). Of the 45 patients with biloma, 10 cases had clinical symptoms that mainly included jaundice and fever, the average diameter of the biloma was significantly larger than that in asymptomatic patients (8.12 mm vs. 21.84 mm, P<0.05), and the biloma was reduced in 8 cases and disappeared in 2 after aspiration drainage; 35 asymptomatic patients received regular review with imaging examinations. Conclusion: For HCC patients with risk factors, preoperative assessment and preventive measures should be taken. Aspiration drainage should be performed in symptomatic biloma patients, and regular review and imaging examinations should be conducted in asymptomatic biloma patients, so as to give timely aspiration drainage for those with enlargement of biloma, which also can offer favorable results.


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引用

引用本文: 昭明 刘, 祯 李, 丙辉 许, 洋 刘, 双玉 齐, 少华 郑, 恒力 李. 肝细胞癌患者介入手术后胆汁瘤发病因素与临床特点[J]. 中国普通外科杂志, 2016, 25(7): 973-978.
Cite this article as: LIU Zhaoming, LI Zhen, XU Binghui, LIU Yang, QI Shuangyu, ZHENG Shaohua, LI Hengli . Pathogenic factors and clinical features of biloma in hepatocellular carcinoma patients after interventional therapy [J]. Chin J Gen Surg, 2016, 25(7): 973-978.