原发性肝癌合并肝动脉-门静脉瘘的相关因素及临床特点

Primary liver cancer complicated with hepatic arterioportal fistula: Clinical characteristics and risk factors

目的:探讨原发性肝癌合并肝动脉-门静脉瘘(hepatic arterioportal fistula,HAPF)发生的部分相关因素及临床特点.方法:152例行肝动脉化疗栓塞术的原发性肝癌患者按血管造影是否合并HAPF分为观察组和对照组,对比分析临床及影像学资料,探讨影响HAPF发生的部分相关因素及临床特点.计量资料采用两样本均数t检验,计数资料采用?2检验或Fisher精确概率法,以P<0.05为差异有统计学意义.结果:观察组在肝功能B级及C级、腹水、上消化道出血及门脉瘤栓发生率高于对照组(t=4.858、4.522、4.496、6.024,均P<0.05),HAPF容易出现于巨块型血供丰富肝癌(P<0.05),两组在合并肝硬化、肝内子灶及甲胎蛋白异常无显著性差异(P>0.05).观察组介入治疗短期内瘘口改善率89.9%,22.2%患者门脉高压症状明显缓解.结论:原发性肝癌合并HAPF产生与肝癌血供丰富、肿瘤巨大及门脉癌栓关系密切,容易损害患者肝功能并加重门脉高压症状.介入栓塞治疗可短期内改善分流并部分缓解临床症状.

AIM： To investigate the clinical characteristics of and risk factors for primary liver cancer （PLC） com- plicated with hepatic arterioportal fistula （HAPF）.METHODS： Clinical and imaging data for 152 patients with PLC who underwent transcath- eter arterial chemoembolization （TACE） were analyzed retrospectively. These patients were divided into HAPF group and control group to analyze the clinical characteristics of and risk factors for PLC with HAPF.RESULTS： The percentages of patients with liver function grade （B＋C）, upper tract hemor- rhage, ascites, or portal vein thrombosis were significantly higher in the HAPF group than in the control group （t = 4.858, 4.522, 4.496, 6.024, allP 〈 0.05）, No statistical differences were noted in liver cirrhosis, disseminated lesions in the liver, and abnormal AFP between two groups （all P 〉 0.05）. HAPF was prone to be present in patients with massive PLC that has rich feeding vessels. Approximately 89.9% of patients had improve- ment of HAPF and 22.2% had remission of portal hypertension shortly after TACE treatment.CONCLUSION： PLC complicated with HAPF is possibly associated with factors including mas- sive tumors with rich tumor feeding vessel and portal vein thrombosis, which tend to impair liver function and aggravate portal vein hypertension symptoms. Proper TACE treatment can improve HAPF and portal hypertension symptoms in a short term.