【摘要】 目的　探讨肝癌介入治疗后肝内胆汁瘤形成的病理基础和临床意义。方法　对 35 0例接受TAE(经导管肝动脉化疗栓塞 )和PEI(经皮肝穿刺癌灶内无水酒精注射术 )治疗的中晚期肝癌患者进行CT随访 ,对疑有胆汁瘤的 11例又行经皮穿刺胆汁瘤造影 ,10例行经皮穿刺活检 ,1例接受外科手术切除 ,所有胆汁瘤均进行外引流或酒精消融治疗。结果　共发现 11例胆汁瘤 (11/ 35 0 ,3.1% ) ,且均呈囊状扩张 (11/ 11)。其中 4例胆汁瘤还伴有边缘模糊的柱状扩张 (4 / 11) ,3例伴有肝内胆管呈“软藤状”扩张 (3/ 11)。病理检查主要表现为胆管壁坏死、胆汁外溢及炎性细胞浸润 ,经外引流或酒精消融处理后 ,9例症状改善 (9/ 11)。结论　胆汁瘤是肝癌介入治疗后由于胆管壁坏死所致的一种并发症。其诊断有赖于影像学检查 ,与残癌鉴别有助于进一步处理。外引流、支架放置和酒精消融是可选择的治疗方法更多还原

【Abstract】 Objective To investigate the pathologic basis of intrahepatic biloma formed in the patients with hepatocellulr carcinoma (HCC) after interventional treatment and to assess its clinical significance. Methods Three hundreds and fifty cases of HCC were followed up with CT examination after TAE/PEI, 11 cases received percutaneous bilomography, 10 cases received percutaneous biopsy, and 1 case had surgical resection. All cases of biloma underwent external drainage of bile or ethanol ablation. Results 11 cases of biloma were found (11/350), and all of them displayed a cystic dilation (11/11), 4 cases showed a columnar dilation with indefinite border (4/11), and 3 cases accompanied with a “soft rattan sign” of intrahepatic bile ducts (3/11). The pathologic findings included necrosis on the wall of the biliary tract, extravasation of bile, and infiltration with inflammatory cells. After the external drainage or the ethanol ablation, jaundice had been decreased and symptoms relieved (9/11). Conclusions Biloma is one of the complications of the patients with HCC after TAE/PEI caused by the necrosis of the wall of biliary tract, the correct diagnosis depends on the imaging procedures and biopsy. It is helpful to the further treatment to distinguish biloma from residual nidus of carcinoma. External drainage, stent placement, and ethanol ablation may be the choice of management.更多还原