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目的 探讨肝动脉栓塞化疗引起肝脏胆道并发症的临床表现、病理改变、发病机理及预防治疗的方法。方法 观察 1990年 6月至 1999年 6月收治 10 8例经过 1～ 6次肝动脉栓塞化疗患者治疗结果。结果 肝动脉栓塞化疗 4次以上者 3 5例 ,发现胆道病变 6例 ,发生率为 17.14 % ;化疗 3次以下者 73例 ,发生 2例 ,为 2 .4 7% ,显著低于前者。结论 发生机理可能主要是因为胆管的营养血管多次被栓塞而没有及时建立起有效的侧支循环 ,胆管缺血 ,管壁发生无菌性炎性增生 ,上级胆管扩张、胆汁淤积、胆石形成。预防治疗措施包括延长治疗间隔时间、辅助其他治疗 ,积极防治原发胆道病变及改善肝胆内循环。
Objective To investigate the clinical manifestations, pathological changes, pathogenesis and prevention and treatment of hepatobiliary complications caused by hepatic artery embolization chemotherapy. Methods From June 1990 to June 1999, we observed the results of treatment of 108 patients undergoing 1 to 6 consecutive cycles of hepatic artery embolization. Results In patients with hepatic arterial embolization and chemotherapy more than 4 times, 35 cases found biliary tract lesions in 6 cases with an incidence of 17.14%; 73 cases with less than 3 times of chemotherapy, and 2 cases with 2.4%, which was significantly lower than the former. Conclusion The mechanism may be mainly due to the multiple embolization of the nutritional blood vessels of the bile duct and failure to establish an effective collateral circulation in time, bile duct ischemia, aseptic inflammatory hyperplasia in the wall of the tube, dilatation of the superior bile duct, cholestasis, and gallstone formation. Prevention and treatment measures include prolonging the interval between treatments, assisting other treatments, actively preventing and treating primary biliary tract lesions, and improving hepatobiliary circulation.