Gas-Forming Pyogenic Liver Abscess Developed after Drug-Eluting Bead Transarterial Chemoembolization Therapy for A Large Hepatocellular Carcinoma: A Case Report and Review of Literature

巨大肝細胞癌經載藥微球肝動脈化療栓塞術後併發化膿性肝膿瘍：病例報告以及文獻回顧

林寶寶(Poh-Poo Lim) ； 郭樂明(Lok-Beng Koay) ； 林勤益(Ching-Yih Lin) ； 許銘仁(Ming-Jen Sheu) ； 郭行道(Hsing-Tao Kuo) ； 孫啟書(Chi-Shu Sun) ； 馮意哲(I-Che Feng) ； 林育民(Yu-Min Lin) ； 謝秉欣(Ping-Hsin Hsieh)

《內科學誌》 26卷2期 (2015/04) Pp. 115-119

https://doi.org/10.6314/JIMT.2015.26(2).07

摘要

經肝動脈栓塞術後併發肝膿瘍是一種罕見但嚴重的併發症，並且伴隨著顯著的死亡率。我們報告一名52歲慢性B肝肝硬化以及第二型糖尿病的病患，住院診斷為巨大肝癌後進行載藥微球肝動脈化療栓塞術。然而術後持續地發燒長達一個星期，因此安排腹部電腦斷層檢查顯示腫瘤嚴重壞死合併肝膿瘍達11.4厘米。隨後我們使用了經皮引流管放置以及強效抗生素治療。經過三週的治療，追蹤腹部超音波顯示膿瘍逐漸縮小，臨床症狀也有顯著的改善。患者出院後在門診持續地追蹤，每三個月的腹部超音波顯示膿瘍以及腫瘤持續消退中。對於高齡、多種合併症以及較大的腫瘤患者，我們應該意識到其在經肝動脈栓塞後的併發症會有高危險性，因此須提高警覺提早診斷及積極治療。

並列摘要

Liver abscess after hepatic artery embolization is a rare but serious complication associated with significant morbidity and mortality. Here we report a 52-year-old case of chronic hepatitis B, liver cirrhosis and diabetes mellitus (DM) type 2 with a large gas forming liver abscess (11.4 cm) developed after transarterial chemoembolization (TACE) treatment for a large hepatocellular carcinoma (HCC). The condition responded well to four weeks of antibiotics treatment plus percutaneous drainage with continuous abscess regression after treatment. Infection of the necrotic tumor seems to be the cause of abscess formation in this case. We suggest that for patient with large tumor size, multiple risk factors such as DM, liver cirrhosis, associated biliary disease and old age; post TACE abscess formation should be highly aware of, investigated early and treated promptly. Prophylaxis antibiotics may also be considered.

並列關鍵字

Hepatocellular carcinoma ； Drug-eluting bead transarterial chemoembolization ； Liver abscess