血管栓塞部位与肝癌介入栓塞治疗后胆管损伤的相关性

摘要/Abstract

摘要： 目的探讨血管栓塞部位与肝癌介入栓塞(TACE)治疗后胆管损伤的相关性。方法纳入我院2018年10月至2019年6月收治的肝癌患者108例,所有病例均行TACE术。根据血管栓塞部位进行分组,分别为肿瘤供应血管组(A组,n=35)、左肝动脉组(B组,n=22)、右肝动脉组(C组,n=25)、肝固有动脉组(D组,n=26)。比较四组的胆管损伤发生率,并分析胆管损伤部位。经Logistic线性回归模型分析胆管损伤的危险因素。结果 A、B、C、D各组胆管损伤发生率分别为14.29%(5/35)、9.09%(2/22)、8.00%(2/25)、11.54%(3/26),四组比较无差异(P>0.05)。在108例患者中,共计12例发生胆管损伤,胆管损伤数目为21个,A、B、C、D各组损伤数目分别为8(38.09%)个、3(14.29%)个、4(19.05%)个、6(28.57%)个。A组损伤部位靠近肿瘤4个,未靠近肿瘤1个,B组损伤部位均位于I段,C组损伤部位均位于V段,D组损伤部位均位于肝门部。Logistic多因素分析提示肿瘤少血供、TACE部位靠近胆管是TACE术后胆管损伤的危险因素(P<0.05)。结论肝癌患者于肿瘤供应血管、左肝动脉、右肝动脉、肝固有动脉处行介入栓塞时,对胆管损伤风险未见明显影响,但介入栓塞部位靠近胆管时,可增加胆管损伤风险。

关键词: 血管栓塞部位, 肝癌介入栓塞术, 胆管损伤, 肝癌

Abstract: Objective To explore the correlation between the site of vascular embolization and bile duct injury after transcatheter arterial chemoembolization (TACE) therapy in liver cancer patients.Methods 108 cases of liver cancer patients underwent TACE were divided into three groups according to the location of embolization:tumor supply vascular group (group A,n=35),left hepatic artery group (group B,n=22),right hepatic artery group (Group C,n=25),and hepatic proper artery group (Group D,n=26).The incidence of bile duct injury was compared among the four groups,and the location of bile duct injury was analyzed.The risk factors of bile duct injury were analyzed by logistic linear regression model.Results The incidence of bile duct injury in group A,B,C and D was 14.29% (5/35),9.09% (2/22),8.00% (2/25) and 11.54% (3/26),respectively,without difference among the four groups (P>0.05).Among the 108 patients,a total of 12 had bile duct injuries,and the number of bile duct injuries was 21.The number of injuries in groups A,B,C and D was 8 (38.09%),3 (14.29%),4 (19.05%),and 6 (28.57%),respectively.In group A,4 injury sites were close to the tumor and 1 wasn't.In group B,all injury sites were located at segment I.In group C,all injury sites were located at segment V.In group D,all injury sites were located at hilum.Logistic multivariate analysis suggested that low blood supply and TACE site proximity to bile duct were risk factors for bile duct injury after TACE (P<0.05).Conclusion Interventional embolization at tumor supply vessels,left hepatic artery,right hepatic artery and proper hepatic artery of liver cancer patients weren't associated with the risk of bile duct injury.However,the risk of bile duct injury increased if the embolization site was close to the bile duct.

Key words: Vascular embolization site, Interventional embolization therapy, Bile duct injury, Liver cancer

战强, 任伟, 韩为清. 血管栓塞部位与肝癌介入栓塞治疗后胆管损伤的相关性[J]. 肝脏, 2020, 25(11): 1171-1174.

ZHAN Qiang, REN Wei, HAN Wei-qing. The correlation between the location of vascular embolization and bile duct injury after interventional embolization therapy of liver cancer[J]. Chinese Hepatolgy, 2020, 25(11): 1171-1174.

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