Objective To investigate the clinical features,related
risk factors,the
efficacy and
safety of clinical management about
liver abscess formation occurring after transcatheter arterial chemoembolization (TACE) for metastatic
liver cancer.
Methods Among 1812
patients with metastatic
liver tumors who were receiving TACE,23
patients developed
liver abscess.The clinical features and
risk factors for
abscess formation were retrospectively analyzed.The curative effects and
safety of percutaneous
puncture cavity
drainage (PCD),or combined with percutaneous transhepatic
cholangiography and
drainage (PTCD) were analyzed.Results The
incidence of
liver abscess after TACE for metastatic
liver tumors was 1.3% (23/1812).Postoperative high
fever,chill,elevated
white blood cell count and increased
neutrophil proportion were the main clinical features of
liver abscess.The mean
time before the
diagnosis of
liver abscess was confirmed was (11.3±3.7) days after TACE.The hepatic metastatic
malignancy originated from the malignant
tumor of
digestive tract was seen in 73.9% of
patients,18
patients (78.3%) had a
history of gastroenteric
surgery,and 12
patients (52.2%) had a
history of
diabetes mellitus.The number of hepatic metastatic lesions was more than 3 in 19
patients (82.6%).After the formation of
liver abscess,the
liver functions became worse in all
patients (P=0.024).In 19
patients (82.6%),
angiography showed that the
metastases were hypovascular lesions.
Blood and
pus cultures revealed that E.coli was the main infectious
bacteria of
liver abscess.The mean
time of using anti-infective
drugs before
hepatic abscess developed
liquefaction was (10.4±3.3) days,and the mean
time of
abscess liquefaction was (15.9±3.7) days.The mean value of the maximum diameters of
abscesses was (9.2±2.0) cm.PCD was employed in all
patients,the average times of PCD
procedure was (3.7±1.7) times.PCD followed by PTCD was performed in 7
patients as they had biloma associated with
obstructive jaundice.The average
drainage time for
liver abscess was (3.1 ±1.7) months.No infectious
peritonitis,
tumor rupture,or
tumor implantation at
puncture point was observed.The median
survival time of 23
patients with
liver abscess was (8.0±0.7) months.The median
survival time in
patients who received PCD
procedure only was (9.0±1.0) months,while it was (5.0±0.7) months in
patients who received PCD together with PTCD,and statistically significant difference in the median
survival time existed between the above two groups (P=0.041).Conclusion The
risk factors of
liver abscess formation after TACE in
patients with metastatic
liver tumors include the site of primary
tumor and gastrointestinal
surgery.Diabetes may be one of the
risk factors.Clinically,the lesions of
liver abscess are usually multiple and they often occur in hypovascular lesions with central
necrosis,The nain infectious
bacteria are from
digestive tract,and biloma is easy to develop.Active and effective
antibiotic treatment plus
puncture drainage of
abscess cavity,or combined with PTCD,are effective
treatment measures for this kind of
liver abscess.