原发性肝细胞癌合并不同类型动静脉瘘的DSA表现与介入治疗

Digital substruction angiography manifestation and interventional therapy of hepatocellular carcinoma combined with different types of Hepatic arterial-portal venous shunts

目的:探讨原发性肝细胞癌合并不同类型动静脉瘘介入治疗的应用价值。方法:入组46例肝癌合并不同类型动静脉瘘患者,分别行肝动脉内化疗栓塞治疗或肝动脉内灌注化疗术,比较分析不同治疗方法的疗效、患者的生存率和对肝功能的影响。结果:DSA诊断肝癌合并动静脉瘘者46例,中央型动门静脉瘘14例,周围型动门静脉瘘24例,混合型8例,轻度动门脉瘘13例,中度动门脉瘘18例,重度动门脉瘘15例。其中同时合并肝动脉肝静脉瘘2例。38例行肝动脉内化疗栓塞术,8例行肝动脉内化疗术。术后所有患者肝功能均有不同程度好转,行肝动脉内化疗栓塞术中位生存时间,2个月、6个月、1年总体累积生存率均高于肝动脉内化疗术患者。结节型及巨块型肝癌中位生存时间,2个月、6个月、1年总体累积生存率相当,且均明显高于弥漫型肝癌。结论:周围型、轻中度动静脉瘘的患者较容易封堵瘘口,而中央型、混合型、重度动静脉瘘患者封堵瘘口难度较大,应尽量使用栓塞剂有效封堵瘘口血流后行经皮肤动脉化疗栓塞,如无法封堵瘘口,则仅行肝动脉内化疗术。

Objective To explore the value of interventional therapy for hepatocellular carcinoma combined with different types of hepatic arterial-portal venous shunts. Methods 46 eases with proved hepatocellular carcinoma （HCC） combined with different types of Hepatic arterial-portal venous shunts were performed respectively with transcatheter arterial chemoembolization （TACE） or transcatheter arterial infusion （TAI）. We compared the curative effect, survival rate and the effects on liver function of the two methods. Results Totally 46 cases were presented by DSA with arterioven0us shunt, including 14 cases with hepatic artery-portal vein shunts of central type, 24 cases with the peripheral type, 8 cases with the mixed type, 13 cases with the mild type, 18 cases with the midrange type, 15 cases with the heavy type, and 2 eases with hepatic arteriovenous shunts. 38 cases were performed with transcatheter arterial chemoembolization （TACE） , while 8 cases were performed with transcatheter arterial infusion （TAI）. Hepatic function were improved after using the two kinds of methods, but the median survival time, two months survival rate, six months survival rate and one year survival rate of the cases who received TACE were higher than the cases who received TAI. The survial time and the survial function of huge hepatic carcinoma and nodulous Hepatic carcinoma are considerable and higher than asystematic hepatic carcinoma. Conclusion The orificium of the peripheral type mild type and midrange type are easier to block than the central type, mixed type and heavy type. When we succeed to block the hepatic artery-portal vein shunts, TACE is used but the Hepatic