Hepatocellular Carcinoma Rupture after Transcatheter Arterial Chemoembolization

肝細胞癌經動脈化學栓塞治療後併發腫瘤破裂：病例報告

英恭史(Kung-Shih Ying) ； 黃旭輝(Shyuh-Huei Huang) ； 趙哲仁(Che-Jen Chao) ； 吳新華(Shin-Hwa Wu) ； 張泰裕(Tai-Yu Chang) ； 李宗憲(Chung-Hsein Lee)

《中華放射線醫學雜誌》 29卷1期 (2004/02) Pp. 41-45

摘要

動脈化學栓塞療法，已被廣泛用在治療無法作開刀手術治療之肝癌病人。經過動脈化學栓塞治療後，發生肝腫瘤破裂之併發症是相當少見的。一個51歲的男性病人，在肝的左葉外節部有一巨大的肝細胞癌（7.2×6.5×5.7公分）；除緊貼在肝包膜外，腫瘤並向外凸出超過肝臟之邊緣界面。而在肝右葉則有一些肝細胞癌，並發現有一大的動脈－門靜脈之不正常交通。另外在血液檢查方面，則發現有血小板過低症。在做左肝動脈化學栓塞治療時，為避免發生肝衰竭及腫瘤破裂，我們只注入了少量的栓塞物（即動脈化學部分栓塞療法）。16小時後，病人發生了肝腫瘤破裂。緊急血管攝影檢查發現，在原本經過栓塞後已發生阻塞之左肝動脈供應支血管，很快的發生了再貫通的情形。此種血管再貫通的情形，可能與我們所使用的部分栓塞技術有關。對於一個易發生肝癌自發性破裂高危險群的病人，即使使用動脈化學部份栓塞療法，亦有可能引起肝腫瘤破裂。臨床及放射科醫師必須知悉此種少見之併發症。

關鍵字

併發症 ； 已破裂的肝細胞癌 ； 經動脈化學栓塞療法

並列摘要

Transcatheter arterial chemoembolization (TACE) is widely used to treat non-resectable hepatocellular carcinoma (HCC). Several complications of TACE have been reported. HCC rupture after TACE is very rare. Here, we reported a 51 years old male patient had a large HCC (7.2×6.5×5.7 cm) with tumor abutting the liver capsule and bulging out of the liver contour in the lateral segment of left hepatic lobe. TACE was performed from left and right hepatic arteries respectively. In order to avoid hepatic failure and tumor rupture, TACE by administering reduced amount of Gelfoam particles (partial embolization) was performed from the left hepatic artery. HCC rupture developed sixteen hours after TACE, when the plain abdomen radiograph showed lipiodol extravasation into the peritoneal cavity. Emergent angiography revealed early recanalization of the embolized peripheral branches of left hepatic artery. This early recanalization may be due to previous partial embolization procedure. In a patient with high risk of spontaneous tumor rupture, rupture of the HCC may occur after TACE even by applying partial embolism or modified TACE techniques.

並列關鍵字

Complication ； Hepatocellular carcinoma ； Transcatheter arterial chemoembolization