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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2016, Vol. 05 ›› Issue (01) : 47 -50. doi: 10.3877/cma.j.issn.2095-3232.2016.01.012

所属专题： 文献；

临床研究

腔内超声造影在肝细胞癌消融术后胆管支气管瘘诊断中的价值
周泽浩1, 黄倩楠1, 许尔蛟1, 郑荣琴1, 李凯1,†()   
  1. 1. 510630　广州，中山大学附属第三医院超声科
  • 收稿日期:2015-11-20 出版日期:2016-02-10
  • 通信作者: 李凯
  • 基金资助:
    国家自然科学基金青年科学基金(81301931)

Value of intracavitary contrast-enhanced ultrasound in diagnosis of biliary-bronchial fistula after hepatocellular carcinoma ablation

Zehao Zhou1, Qiannan Huang1, Erjiao Xu1, Rongqin Zheng1, Kai Li1,†()   

  1. 1. Department of Ultrasound, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2015-11-20 Published:2016-02-10
  • Corresponding author: Kai Li
  • About author:
    Corresponding author: Li Kai, Email:
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引用本文：

周泽浩, 黄倩楠, 许尔蛟, 郑荣琴, 李凯. 腔内超声造影在肝细胞癌消融术后胆管支气管瘘诊断中的价值[J]. 中华肝脏外科手术学电子杂志, 2016, 05(01): 47-50.

Zehao Zhou, Qiannan Huang, Erjiao Xu, Rongqin Zheng, Kai Li. Value of intracavitary contrast-enhanced ultrasound in diagnosis of biliary-bronchial fistula after hepatocellular carcinoma ablation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(01): 47-50.

目的

探讨腔内超声造影在肝细胞癌（肝癌）消融术后胆管支气管瘘诊断中的价值。

方法

回顾性分析2012年2月在中山大学附属第三医院接受诊治的1例肝癌消融术后胆管支气管瘘患者临床资料。患者已签署知情同意书，符合医学伦理学规定。患者男，56岁，2010年9月超声引导下行肝癌射频消融，术后1个月复查提示消融完全，且未见明显肿瘤复发。术后10个月开始出现反复发热并于术后17个月出现咳胆汁痰等症状。经MRI检查发现原消融灶部位胆汁湖形成，遂行胆汁湖穿刺置管，并行透视检查及腔内超声造影检查明确诊断。

结果

腔内超声造影检查发现胆管瘘道通向右侧胸腔。置管引流后患者症状缓解，其后行腔内超声造影复查提示胆管瘘道消失，胆汁湖持续存在，随后行右半肝切除术，治愈出院。

结论

肝癌消融后胆管支气管瘘是一种罕见并发症，腔内超声造影检查可作为其诊断治疗的良好补充手段。

关键词: 肝肿瘤, 腔内超声检查, 导管消融术, 并发症
Objective

To evaluate the value of intracavitary contrast-enhanced ultrasound in the diagnosis of biliary-bronchial fistula after hepatocellular carcinoma ablation.

Methods

Clinical data of 1 case with biliary-bronchial fistula after hepatocellular carcinoma ablation in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The informed consent was obtained and the local ethical committee approval had been received. The male patient, aged 56 years, underwent ultrasound-guided hepatocellular carcinoma radiofrequency ablation in September 2010. Examination revealed the tumor was completely ablated and no recurrence was detected 1 month after ablation. Ten months after operation, the patient suffered from recurrent fever and developed coughing up of bile-stained sputum at 17 months after ablation. MRI examination indicated the formation of a bile lake at the ablation site and percutaneous catheter drainage was performed. The diagnosis was confirmed by fluoroscopic and intracavitary contrast-enhanced ultrasound examination.

Results

The biliary fistula tract was found connected to the right chest by intracavitary contrast-enhanced ultrasound examination. After drainage the patients' symptoms were relieved. The biliary fistula tract disappeared when checked by intracavitary contrast-enhanced ultrasound but the bile lake still existed. Right hemihepatectomy was performed subsequently. The patient was cured and discharged.

Conclusions

Biliary-bronchial fistula is a rare complication after hepatocellular carcinoma ablation. Intracavitary contrast-enhanced ultrasound could serve as a useful complementary method for the diagnosis and treatment of biliary-bronchial fistula.

Key words: Liver neoplasms, Endosonography, Catheter ablation, Complications
图1 肝癌射频消融术后胆管支气管瘘常规超声及腔内超声造影图
表1 肝癌射频消融术后胆管支气管瘘病例报道情况
研究者 发表时间（年份） 瘘管位置 病灶位置 临床表现 诊断方法 治疗方法
Liberale等[8] 2004 右侧胸腔 S3、S4 呼吸急促 ERCP 胆管支架扩张术
Kim等[9] 2005 右侧胸腔 S7 咳淡黄色痰、右上腹痛 PTC PTCD
Tran等 [10] 2007 右侧胸腔 S8 咳黄绿色痰、右胸痛 ERCP 括约肌切除术+胆管支架扩张术
Pende等[11] 2007 右侧胸腔 S5、S8 咳嗽、呼吸急促 ERCP 经内镜鼻胆管引流术+经皮支架成形术
Yoon等 [12] 2009 右侧胸腔 S7、S8 咳绿色痰、右上腹疼痛 PTC PTCD
Jung和Park [13] 2012 右侧胸腔 S8 咳嗽、右胸痛 PTC PTCD
Kim等 [14] 2013 右侧胸腔 S7 咳嗽、咳黄绿色痰 ERCP 手术切除+胆汁引流
王继涛等[15] 2014 右侧胸腔 S7、S8 咳嗽、咳黄绿色痰 手术探查 手术修补漏道
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