肝动脉化疗栓塞术后胆囊炎

目的：探讨肝动脉化疗栓塞（TACE）术后并发胆囊炎的影像特点、临床表现及病因。资料与方法：回顾性分析TACE术后并发胆囊炎患者的临床及影像资料，其中原发性和继发性肝癌138例，肝血管瘤4例，观察其胆囊动脉及胆囊血管造影表现；胆囊炎症状和体征；白细胞计数及分类；B超和／或CT胆囊形态变化。对于确诊为胆囊炎的患者，分析其所应用的化疗方案。结果：17例患者（肝癌14例，血管瘤3例）TACE后并发胆囊炎（12％），其中术后即刻血管造影示胆囊动脉和／或其分支闭塞，胆囊染色11例，发热17例，右季肋部疼痛17例，10例伴右肩部放射，Murphy征阳性17例。17例白细胞总数及中性粒细胞百分比均有明显增加。术后腹部B超（12例）、CT（5例）示胆囊壁增厚、水肿，胆囊窝渗出。14例TACE后并发胆囊炎的肝癌患者化疗方案为：BLM5例，DDP（或CP）4例，BLM＋DDP或CP2例，EADM3例；3例肝血管瘤患者仅用BLM。结论：TACE后胆囊炎的发生与胆囊动脉的解剖、导管尖端的位置、栓塞剂、化疗药等多种因素有关，应综合临床、影像、实验室检查等资料作出诊断，及时治疗，避免胆囊穿孔等严重并发症的发生。

Cholecystitis post Transcatheter Arterial Chemoembolization

Objective To discuss the clinical presentations, radiological features and the etiology of cholecystitis developed after transcatheter arterial chemoembolization (TACE).Materials and Methods TACE was performed in 138 patients with primary or metastatic hepatic cancer and in 4 patients with hepatic cavernous hemangioma. The clinical data and imaging materials, including symptoms and signs of cholecystitis, differential leukocyte count, angiographic findings of gallbladder and cystic arteries, and the gallbladder morphology on USG and CT, were retrospectively analyzed. The adopted chemotherapeutic programs in the patients confirmed to suffer from cholecystitis was reevaluated.Results Of total 142 patients, post-TACE cholecystitis developed in 17 (12%). Angiography done immediately after TACE showed occlusion of cystic arteries and/or its branches in 12 cases. Clinically, fever occurred in 17 cases, pain at right hypochondriac region in 17 (accompanying radiating pain of right shoulder in 10), and positive Murphy sign was detected in 17. Significant leukocytosis and neutrophilia were seen in all patients. On post-TACE USG (n=12) and CT (n=5), thickened edematous cystic wall and effusion in the gallbladder fossa were demonstrated. The chemotherapeutic programs used in the 14 patients who complicated post-TACE cholecystitis included BLM (n=5), DDP (n=4), BLM+DDP or CP (n=2) and EADM (n=3). Three patients with hepatic cavernous hemangioma received BLM only.Conclusion The occurrence of post-TACE cholecystitis is associated with a lot of factors, such as the anatomy of the cystic artery, the placed position of the catheter's tip, and both the embolic and chemotherapeutic agents used in the treatment. The diagnosis should be made by a comprehensive evaluation of all the clinical, imaging and laboratory data. Prompt and proper treatment can avoid the occurrence of gallbladder perforation and other severe complications.