肝血管瘤合并动静脉瘘的DSA表现及介入治疗

Particular DSA Findings of Cavernous Hemangioma of the Liver Complicated with Arteriovenous Fistulas and the Interventional Therapy

目的:回顾性分析肝海绵状血管瘤(CHL)合并动静脉瘘(AVF)的数字减影血管造影(DSA)的特征性表现并探讨合理的治疗方法。方法:分析合并AVF的26例CHL的完整DSA及经平阳霉素碘油乳剂肝动脉栓塞(PLE-TAE)治疗的资料。改进造影技术采集DSA图像,采取超选择插管行PLE-TAE后再用明胶海绵颗粒栓塞瘘口及少量无水酒精闭塞瘘口后再行PLE-TAE等处理方法。结果:CHL合并的AVF的DSA的特征性表现为瘘口较为局限,多位于瘤周近供血动脉处;以周围型动-门静脉瘘(APVF)为多见;分流量多较小;AVF供血动脉无浸润破坏现象。对瘘口采取适当的处理措施后,AVF中碘油沉积静脉数较TAE前DSA显著减少(P<0.01),邻近肝组织亦未见明显碘油异常沉积。结论:CHL中AVF有较高的发生率且有特征性DSA表现。通过适当处理可以显著减少或避免PLE异常沉积及其可能造成的肝脏和肺脏纤维化。

Objective： Retrospectively study particular DSA findings of cavernous hemangioma of the liver （CHL） complicated with arteriovenous fistulas （AVF） and exploring appropriate managing measures. Methods：Analyzing 26 cases of hemangloma of the liver complicated with arteriovenous fistulas,all the cases were performed DSA and transarterial embolization （TAE） using pingyangmycin lipiodol emulsion （PLE）. After AVF confirmed by DSA,TAE under superselectively cathetering and then occluded AVF using gelfoam particles, or occluded AVF with trifle anhydrous ethanol and then TAE,were performed again. Results：Particular findings of AVF of CHL in DSA were as follows：AVF localizing on around CHL and adjacent to feeding arteries to CHL; peripheric arterio-portal venous fistulas （APVF） being in the majority;lesser shunt volume being in the majority; feeding arteries to AVF showing normal. After appropriate managing measures,lipiodol sediment venous number in AVF was significantly decreased （P〈0.01）, and remarkable abnormal lipiodol distributing was not found. Conclusions：AVF of CHL in DSA has high frequency and particular findings;appropriate managing measures can significantly decrease abnormal lipiodol distributing and potential fibrosis of lung and liver.