肝癌合并肝动-静脉瘘的数字减影血管造影表现及介入治疗

DSA presentations and interventional treatment of arteriovenous shunting(AVS) in hepatocellular carcinoma

目的探讨肝癌合并肝动-静脉瘘(AV S)的数字减影血管造影(DSA)表现及介入治疗方法。方法对55例经CT、B超、M R等证实的肝癌患者行介入治疗时先经肝动脉造影,再行肝动脉内灌注栓塞治疗。结果出现18例(32.72%)合并AV S,并根据不同情况先用明胶海绵栓塞闭塞瘘口,再行化疗和碘油栓塞,16例合并AV S患者经明胶海绵栓塞后瘘口全部闭塞,11例碘油沉积良好,5例部分沉积,2例没用碘油栓塞。临床症状均得到不同程度改善。结论DSA影像可直接显示AV S的类型、部位及程度,对肝癌化疗栓塞时对瘘口相应处理,不但可以提高疗效而且可以减少并发症。

Objective To explore DSA presentations and therapeutic methods of tanscatheter hepatic artery chemoembolization（TACE） of hepatocellular carcinoma combined with arteriovenous shunting. Methods The common hepatic artery angiography was performed in 55 cases with hepatocellular carcinoma confirmed by CT,BUS or MRI before the hepatic artery chemoembo[ization was done, Results 18 cases （32. 72%） were combined with AVS,according to different presentations of DSA. The sponge-embolization was taken before the lipiodle-embolization. Shuntings in 16 cases were successfully embolized. Iodine-oil was deposited well in 11 cases,but 5 cases had partial deposition and 2 cases no lipiodle-embolization. All clinical syndromes were improved. Conclusion The type,site and degree of AVS can be demonstrated directly with DSA. Embolization with sponge followed by lipiodle not only improves the therapeutic effects,but also reduces the complication of AVS.