探讨巨大肝囊肿无水乙醇硬化治疗后胆道损伤并发症的治疗与防范。

本文研究对象为2009年1月至2020年12月期间首都医科大学附属北京天坛医院收治的巨大肝囊肿（最大切面长径≥10 cm）行超声引导下经皮抽吸无水乙醇硬化治疗的30例患者（包括1例多囊肝患者）。肝囊肿硬化治疗采用经穿刺针或引流管无水乙醇置换给药方法。行置管引流硬化治疗患者记录引流囊液的量、颜色及拔除引流管时间。分析巨大肝囊肿硬化治疗后主要并发症发生情况及远期疗效。

30例患者共30个巨大肝囊肿接受了超声引导下经皮穿刺抽吸或置管引流联合无水乙醇硬化治疗，3例行穿刺抽吸硬化治疗，27例行置管引流硬化治疗。30个囊肿最大切面长径为10~18 cm，每个囊肿抽出淡黄色或清亮囊液400~2500 ml，每个囊肿一次硬化治疗无水乙醇总用量为200~300 ml，分4~6次注入。27例行置管引流硬化治疗患者中，26例引流管留置时间为3~5 d，1例引流管留置时间为10 d。2例（6.7%）治疗中发生囊内多量出血，借助引流管压迫作用出血自然停止；3例（10.0%）硬化治疗后并发胆道损伤，经置管引流胆漏停止后拔除引流管，拔管时间分别为3 d、2周及3个月，3例患者的囊肿最终完全吸收或大部分吸收且无远期复发。30例患者，1例行两次硬化治疗，29例行一次硬化治疗，硬化治疗后平均随访15（13~64）个月，总有效率100%（30/30），治愈及显效率为76.7%（23/30）。

巨大肝囊肿行经皮穿刺无水乙醇硬化治疗并发胆道损伤风险增加，置管引流硬化治疗有助于预防和及时发现早期胆道损伤，硬化治疗所致胆道损伤及含胆汁囊肿行置管引流治愈可能性大，宜予以足够时间期待观察。

To investigate the treatment and prevention of biliary tract injury following absolute ethanol sclerotherapy for large liver cysts.

From January 2009 to December 2020, 30 patients with large liver cysts (with a maximum cross-sectional length ≥10 cm) treated with ultrasound-guided percutaneous absolute ethanol sclerotherapy at Beijing Tiantan Hospital affiliated to Capital Medical University were included in this study, including one patient with polycystic liver disease. Absolute ethanol was used for the sclerotherapy of liver cysts via needle aspiration or catheter drainage. In patients treated with catheter drainage and sclerotherapy, the amount and color of cyst drainage fluid and the extubation time were recorded after treatment. The main complications and long-term efficacy of sclerotherapy for large liver cysts were analyzed.

Thirty patients with 30 large liver cysts were treated with ultrasound-guided percutaneous absolute ethanol sclerotherapy, of whom 3 patients underwent needle aspiration and sclerotherapy and 27 underwent catheter drainage and sclerotherapy. The maximum cross-sectional length of the 30 cysts was 10-18 cm, a total of 400 ml to 2500 ml of light yellow or clear fluid was extracted from each cyst, and 200ml to 300 ml of absolute ethanol was injected into each cyst cavity during one session of sclerotherapy, which was divided into 4-6 injections. Among 27 patients treated with catheter drainage and sclerotherapy, the indwelling time of the drainage tube was 3-5 days in 26 patients and 10 days in 1 patient. Two patients (6.7%) had excessive intracapsular hemorrhage during treatment, and the bleeding stopped spontaneously due to compression of the drainage tubes. Three patients (10.0%) developed biliary tract injury after sclerotherapy, who were treated with catheter drainage and the catheters were removed until bile leakage stopped; the extubation time was 3 days, 2 weeks and 3 months, respectively, and the three patients' cysts were completely or mostly absorbed without recurrence. Of the 30 patients included, 29 received one session of sclerotherapy and 1 received two sessions of sclerotherapy. With a median follow-up period of 15 (range 13-64) months in 30 patients, the total effective rate was 100% (30/30), and the cure and significant effective rate was 76.7% (23/30).

There is an increased risk of biliary tract injury following absolute ethanol sclerotherapy for large liver cysts adjacent to primary or secondary bile ducts. Catheter drainage with sclerotherapy is helpful to prevent and detect early biliary tract injury. Bile containing cyst and biliary tract injury following sclerotherapy are likely to be cured by catheter drainage, which should be given sufficient observation time.