肝癌合并肝动-静脉瘘的介入治疗

Interventional therapy of arteriovenous shunting in primary hepatocellniar carcinoma

目的探讨原发性肝癌合并动一静脉瘘的血管造影表现及介入治疗效果。方法回顾性分析85例原发性肝癌伴有肝动-静脉瘘患者的临床资料。85例中肝动脉-门静脉瘘79例,其中9例伴有肝动脉-肝静脉瘘,单纯肝动脉-肝静脉瘘6例。所有患者均给予肝动脉内化疗栓塞术(TACE)和肝动脉内化疗灌注(TAI)治疗。78例根据动-静脉瘘特点,采用弹簧圈、明胶海绵颗粒或PVA颗粒封堵瘘口并行碘油栓塞。7例因瘘口大,同时有门静脉主干瘘,未能封堵,仅行化疗灌注。结果59例一次封堵成功,19例肝内有大小不等的多发瘘口,反复栓塞,仍有少量瘘口不能完全封堵。在后续介入治疗中发现,瘘口封堵成功者,26例瘘口重新开通或有新的瘘口出现,再次封堵瘘口后成功。一月后CT复查,56例肿瘤明显缩小,乙碘油沉积良好,占全部病例的66%。13例肿瘤缩小不明显,乙碘油沉积较少,占15%。16例肿瘤增大,占19%,总有效率81%。65例甲胎蛋白(AFP)阳性的患者中59例术后AFP值下降。结论原发性肝癌合并动-静脉瘘使介入治疗的难度增加,术中有效的封堵瘘口可为肝癌的进一步治疗创造机会,延长患者的生存时间,提高生命质量。

Objective To explore the appearances of digital subtraction angiography and therapeutic efficacy of interventional therapy of hepatic carcinoma accompanied with arteriovenous shunting（AVS）.Methods To retrospectively analyze clinical material of 85 patients with hepatocellular carcinoma with hepatic arteriovenous shunting.Of whom,70 with hepatic artery-portal vein shunt,6 with hepatic artery-hepatic vein shunt,and 9 with both such two types.A11 the patients were treated with transcatheter arterial chemoembolization（TACE）or transcatheter arterial infusion chemotherapy（TAI）.78 patients has their tumors embolized with lipidol and shunts embolized by spongia gelatinosa particle,coil,or PVA particle respectively.The remaining 7 were treated only with TAI.Results 59 shunts were completely closed successfully.19 shunts were partly closed and 7 shunts were not closed.In 26 patients,the shunts reopened or new shunt emerged in later therapy,and they were closed after second embolization.All the patients underwent CT scan a month afer therapy：the tumors were smaller in 56（66%） and lipidol deposition was satisfied,bigger in 16（19%）,and 13（15%）were the same in size before and after TACE.In 65 alpha fetoprotein（AFP） positive patients,degree of AFP in59 patientsdecreased.Conclusion Primary hepatic carcinoma with AVS increases difficulty of interventional therapy,while as long as we embolize the shunt effectively,we could make it possible for further treatment and elongate the survival span,improve quality of life.