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目的:探讨肝癌介入治疗后并发胆汁瘤的CT表现,对其进行动态观察。方法:回顾分析2001年1月—2009年5月866例行介入治疗的肝癌患者资料,术后有3～9次CT复查,其中15例并发,共22个胆汁瘤;男12例,女3例,年龄24～81岁,平均45.6岁;右肝13例,左肝2例,单发胆汁瘤11例,多发胆汁瘤4例,其中2个病灶2例,3个及4个病灶各1例;胆汁瘤大小:1.8～3cm12个,3.1～5cm7个,5.1～7.5cm3个;介入治疗次数为3～8次,平均4.2次。结果:15例22个胆汁瘤中呈囊状改变14例21个,柱状改变1例1个。经5～15月随访观察,同时给予利胆、保肝、降黄、消炎等治疗,CT影像变化如下:小病灶组(1.8～3cm)12个,基本消失9个,无明显变化3个;中病灶组(3.1～5cm)7个,基本消失4个,明显变小2个,无变化1个;大病灶组(5.1～7.5cm)3个,缩小1个,缓慢增大2个,并发梗阻性黄疸2例,行经皮肝穿刺造影引流,同期行胆汁瘤内无水酒精注射,随访示瘤体明显变小,黄疸消退,好转出院。结论:胆汁瘤是肝癌介入治疗后并发症之一,≤5cm的胆汁瘤经内科治疗大部分可基本消失,少部分变小或无明显变化,病情稳定;>5cm胆汁瘤经内科治疗难消失,可缓慢增大,因压迫相邻胆管,可并发梗阻性黄疸,采用皮肝穿刺造影引流、无水酒精注射等措施可对其进行有效治疗。
Objective: To investigate the CT manifestations of bile tumor after interventional treatment of hepatocellular carcinoma (HCC) and to observe the CT findings dynamically. Methods: The data of 866 patients with HCC from January 2001 to May 2009 were retrospectively analyzed. There were 3 to 9 CT examinations after operation, of which 15 cases complicated with 22 bile tumors. There were 12 males and 3 females Cases, aged 24 to 81 years old, an average of 45.6 years old; right liver in 13 cases, 2 cases of left liver, 11 cases of single bile tumor, multiple bile tumors in 4 cases, including 2 lesions in 2 cases, 3 and 4 lesions 1 Cases; bile tumor size: 1.8 ~ 3cm12, 3.1 ~ 5cm7, 5.1 ~ 7.5cm3; Interventional treatment for 3 to 8 times, an average of 4.2 times. Results: Twenty-two cases of cyst changes in 15 cases of 22 biliary neoplasms were found, while one case of columnar changes was found in one case. After 5 to 15 months of follow-up, concomitant treatment with tilapia, hepatoprotective, yellowing, anti-inflammatory and so on. The changes of CT images were as follows: 12 of the small lesions group (1.8-3cm) disappeared 9, (3.1 ~ 5cm), 7 disappeared, 4 disappeared, 2 obviously smaller, no change 1, 3 large lesions (5.1 ~ 7.5cm), 1 narrowed and 2 slowly increased. Obstructive jaundice in 2 cases, percutaneous transhepatic angiography drainage, bile duct during the same period of anhydrous alcohol injection, follow-up showed significantly smaller tumor, jaundice subsided, improved discharged. Conclusion: Bile neoplasm is one of the complications after interventional treatment of liver cancer. Most of bile neoplasms ≤5cm can disappear after medical treatment, and some of them become smaller or no obvious changes, the disease is stable. The treatment of> 5cm bile tumor is difficult to disappear after medical treatment, Can be slowly increased, due to oppression of the adjacent bile duct, obstructive jaundice can be complicated by the use of cutaneous liver puncture contrast drainage, anhydrous alcohol injection and other measures can be effective treatment.