肝细胞癌肝动脉门静脉分流形成的相关因素分析

The factors related to the formation of arterioportal shunting in patients with hepatocellular carcinomas

目的总结肝细胞癌(HCC)合并肝动脉门静脉分流(APS)、肝动脉肝静脉分流(AVS)的发生率,并探讨影响HCC APS形成的相关因素。方法回顾分析2009年1月-2010年12月经动脉栓塞(TAE)治疗的.497例HCC患者的影像学和病历资料,总结APS、AVS的发生率,采用单因素分析APS的发生与HCC患者性别、年龄、乙型肝炎病史、肝硬化基础、肝癌切除史、甲胎蛋白(AFP)、肿瘤类型、肿瘤数目和门静脉癌栓(PVTT)的相关性,并行多因素Logistic回归分析。结果HCC合并APS的发生率为10.5%(52/497),合并AVS的发生率为1.6%(8/497),同时合并APS与AVS的有3例(0.6%)。单因素分析显示:乙型肝炎病史、肝硬化基础、肿瘤类型、肿瘤数目和门静脉癌栓与HCC患者APS的发生相关;多因素Logistic回归分析显示:肝硬化基础、巨块型肿瘤、肿瘤多发、门静脉癌栓是HCC合并APS发生的危险因素。结论HCC患者有肝硬化基础、巨块型肿块、多发肿瘤。

Objective To summarize the incidence of arterioportal shunting （APS） and arteriovenous shunting （AVS） in patients with hepatocellular carcinoma （HCC）, and to investigate the relevant factors affecting the formation of APS in patients with HCC. Methods During the period from January 2009 to December 2010, transarterial embolization （TAE） was carried out in 497 patients with HCC. The clinical data and imaging findings were retrospectively analyzed. The incidences of APS and AVS were calculated. The patient＇s sex, age, hepatitis B history, liver cirrhosis, surgical resection history, serum alpha-fetoprotein （AFP）, tumor type, lesion＇s number and portal vein tumor thrombus （PVT]＇）, etc. were determined. By using single variate analysis and multivariate logistic regression method, the correlation between APS and the above mentioned factors was analyzed. Results The incidence of APS, which was associated with HCC, was 10.5% （52/497）, while the incidence of AVS was 1.6% （8/497）. APS and AVS coexisted in 3 patients （0.6%）. Single variate analysis indicated that hepatitis B history, liver cirrhosis basis, tumor type, lesion＇s number and PVTI＂ bore a close relationship to the formation of APS in HCC. The multivariate logistic regression analysis showed that liver cirrhosis basis, massive type of tumor, multiple lesions and PVTT were the risk factors to induce the formation of APS in HCC. Conclusion In patients with HCC, the basis of liver cirrhosis, massive type of tumor, multiple lesions and PVTF are the main risk factors to induce the formation of APS.