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Intrahepatic Biloma Formation (Bile Duct Necrosis) After Transcatheter Arterial Chemoembolization

¹ Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
² Department of Radiology, Inoue Hospital, 8-9 Takaramachi, Nagasaki 852-0045, Japan.
³ Department of Radiology, National Nagasaki Medical Center, 2-1001-1 Kubara, Omura 856-0835, Japan.
⁴ Department of Radiology, Nagasaki Municipal Hospital, 6-39 Shinchi-machi, Nagasaki 850-0842, Japan.
⁵ Second Department of Surgery, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan.
⁶ Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki 852-8501, Japan.
⁷ Department of Radiology, Yamaguchi University School of Medicine, 1-1-1 Kogushi, Ube, Yamaguchi 755-8505, Japan.

OBJECTIVE. The purpose of our study was to discuss the incidence, predisposing factors, and clinical course of intrahepatic biloma after transcatheter arterial chemoembolization for hepatic tumors including hepatocellular carcinoma and metastatic liver tumor.

MATERIALS AND METHODS. Nine hundred seventy-two patients with hepatocellular carcinoma (n = 920) or metastatic liver tumor (n = 52) underwent chemoembolization during a 12-year period beginning in January 1989. We retrospectively reviewed the medical records and follow-up radiographs of chemoembolization and analyzed the risk factors associated with the development of intrahepatic biloma.

RESULTS. Intrahepatic biloma developed after chemoembolization in 35 patients (3.6%, 35/972) in our series. The incidence of intrahepatic biloma formation in patients with metastatic liver tumor (9.6%, 5/52) was higher than that in patients with hepatocellular carcinoma (3.3%, 30/920) (p < 0.05, Fisher's exact test). The incidence of intrahepatic biloma formation in patients with hepatocellular carcinoma was statistically higher in patients with main tumor size of less than 5 cm and in those with the presence of intrahepatic bile duct dilatation. Technique-related risk factors such as injection site of drugs, repeated chemoembolization with frequency of less than 3 months, and regimen of chemoembolization significantly influenced the incidence of biloma formation in patients with hepatocellular carcinoma. No patient died of infected biloma or septicemia, but one patient died of hepatic failure 2 months after chemoembolization.

CONCLUSION. Biloma formation was significantly more prevalent in the metastatic lesion group than in the hepatocellular carcinoma group. Significant prognostic factors for biloma formation in patients with hepatocellular carcinoma were tumor size of less than 5 cm, bile duct dilatation, proximal injection site, repeated injection with frequency of less than 3 months, and injection of a suspension of anticancer drugs.

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