复合型栓塞剂治疗肝癌合并动静脉瘘

Mixing Embolic Agent in the Treatment for Severe Arterio-venous Shunt in Patients with Hepatocellular Carcinoma

[目的]评估经肝动脉导管内注射明胶海绵浆—化疗药物碘油乳剂(复合型栓塞剂)治疗肝癌合并高流量动静脉瘘(arterio-venous shunting,AVS)的疗效。[方法]共有98例合并高流量AVS肝癌患者施行瘘口封堵术。按照患者意愿进行分组,治疗组(n=36)采用复合型栓塞剂封堵瘘口,再行经导管动脉内化疗栓塞术(transcatheter arterial chemoembolization,TACE)。对照组(n=62例)采用单纯明胶海绵颗粒封堵瘘口,再酌情行TACE术。术后观察两组患者严重不良反应、瘘口完全闭塞率、再通率、近期疗效以及生存率。[结果]治疗组和对照组AVS完全闭塞率分别为100%、80%,瘘口再通率为10%、60%,肿瘤近期疗效80%、50%,6、12、24个月生存率90%、75%、30%和80%、50%、10%,均具有统计学差异,P<0.05。两组患者未发生严重感染、肝功能衰竭、消化道出血、肺梗死、手术相关死亡等严重不良反应。[结论]与单纯明胶海绵相比,采用明胶海绵浆—化疗药物碘油乳剂封堵肝癌AVS不仅简便易行,且疗效更确切,从而延长患者生存期。

[Purpose] To evaluate the effect of mixing embolic agent（MEA） in the treatment for hepatocellular carcinoma（HCC） with severe arteriovenous shunting（AVS） in HCC.[Methods] Of 98 cases with HCC complicated with AVS,66 cases with MEA（MEA group） and 62 with gelfoam（gelfoam group） enrolled for interventional treatment.Serious side effects,complete occlusion of the shunt,frequency of recanalization of shunt,short-term response and survival were analyzed between the two groups after interventional procedures.[Results] The complete occlusion rate of AVS,was 100% and 80% in MEA group and gelfoam group respectively;recanalization rate of 4~6 weeks after embolization,10% and 60%;short-term response rate,80% and 50%;6,12,24 months survival rates,90%,75%,30% and 80%,50%,10% in MEA group and gelfoam group respectively.There were significant differences between the two groups.The serious adverse event such as severe infection,failure in liver function,digestive tract hemorrhage,pulmonary infarction,death related to operation,etc were not found in the two groups.[Conclusion] Comparing with single gelfoam embolization mixing embolic agent embolization for HCC patients with severe AVS is efficacious and safe,and may contribute to prolongation of the life span.