介入处理肝癌并动静脉瘘的血流改变的临床意义

The Clinical Significanc of Interventional Cure to the Change of Blood Flow of Arteriovenous Shunting in Primary Hepatocellular Carcinoma

目的探讨中晚期肝癌并动静脉瘘的机理、介入治疗前后血流改变的DSA表现及临床意义。方法回顾分析介入处理105例中36例肝癌并动静脉瘘的血流DSA表现及其临床价值。中央型12例,周围型24例。门静脉均见癌栓。30/36例完全阻断血流后行TACE,栓塞前、中、后用碘油、明胶海绵、无水酒精或弹簧圈对AVS填塞。6/36例未能完全阻断血流行TAI术,均为AVS不成功或不能够填塞阻断血流。结果全部病例DSA均可以完全显示AVS的部位、类型及血流改变程度。30/36例可完全填塞AVS阻断血流后有效行TACE。6/36例未能填塞AVS及阻断血流仅行TAI。结论DSA能够直接、全面显示AVS部位、类型及血流改变程度。对于轻中度AVS可阻断血流后行TACE安全,对重度流量大的仅行TAI。

Objective To explore the DSA manifestation and interventional cure of arteriovenous shunting in primary hepatocellular carcinoma of advanced stage and the change of blood flow.Methods Retrospectively analyzing the DSA manifestation in 36/105 cases with hepatocellular carcinoma AVS and the clinical significanc of interventional cure,central type 12 cases,milieu type 24 cases.The carcinoma cork was demonstrated in all cases by DSA.30/36 cases were tamponaded after the AVS＇s blood flow was blocked completely with lipiodol, gelatinsponge or anhydr-alcohol before,among or after TACE.6/36 cases could not tamponade the AVS but treated with TAI.Results DSA can demonstrate the type,the site and the degree of AVS completely and directly in all cases.30/ 36 cases were treated with TACE,and the AVS tamponaded completely.The AVS can not be tamponaded or incompletely tamponaded in 6/36 cases with TAI only.Conclusion DSA can demonstrate the type,the site and the degree of AVS completely and directly.TACE is safe and effective for mild or moderate after the AVS＇s blood flow is blocked completely but the severe AVS has to be treated with TAI only.