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간세포암 환자에서 경동맥화학색전술 후 종양혈전의 이동에 의해 합병된 급성 폐쇄성 담관염: 증례보고 및 문헌고찰
박형철 ( Hyung Chul Park ),박현범 ( Hyun Bum Park ),정조윤 ( Cho Yun Chung ),정민우 ( Min Woo Jung ),주영은 ( Young Eun Joo ),최성규 ( Sung Kyu Choi ),조성범 ( Sung Bum Cho ) 대한소화기학회 2014 대한소화기학회지 Vol.63 No.3
Intraductal tumor invasion of hepatocellular carcinoma (HCC) is considered rare. Transarterial chemoembolization (TACE) is effective for tumor thrombus of HCC in the bile duct. However, a few cases of obstructive jaundice caused by migration of a tumor fragment after TACE have recently been reported. The aim of this study was to identify factors that affect tumor migration after TACE. At this writing, a review of the medical literature disclosed seven reported cases of biliary obstruction caused by migration of a necrotic tumor cast after TACE. We, herein, report on an additional case of acute obstructive cholangitis complicated by migration of a necrotic tumor cast after TACE for intrabile duct invasion of HCC, in a 71-year-old man. The tumor cast in the common bile duct was removed successfully using a basket during ERCP and was pathologically confirmed to be a completely necrotic fragment of HCC. The patient`s symptoms showed dramatic improvement. In summary, physicians should be aware of acute obstructive cholangitis complicated by tumor migration in a patient undergoing TACE. We suggest that an intrabile duct invasion would be a major predisposing factor of tumor migration after TACE and drainage procedures such as ERCP or percutaneous transbiliary drainage could be effective treatment modalities in these patients.