肝癌合并动静脉/门脉分流的DSA分型与栓塞治疗

DSA typing and embolotherapy for hepatocarcinoma with arteriovenous shunts

目的:探讨并总结肝癌合并动静脉/门脉分流的DSA分型及介入栓塞封堵治疗方法。方法:32例肝癌合并动静脉/门脉分流经DSA检查分型和介入栓塞治疗,根据分流速度将其动静脉分流分为3型:①快速型;②慢速型;③中速型,选择相应的栓塞材料进行栓塞封堵治疗。结果:快速型6例,慢速型16例,中速型10例。23例(72%)一次封堵成功,4例(13%)二次封堵瘘口消失,3例(9%)因分流口较大,同时伴有门静脉癌栓,未行封堵术,2例(5%)因分流口较多且分散,只进行了部分分流口封堵及栓塞化疗。32例中20例DSA同时显示合并门静脉癌栓,超声仅检出16例。结论:中晚期肝癌患者栓塞术前DSA检查可准确显示动静脉/门脉分流和癌栓情况,采用分流速度分型法简便、实用并对栓塞治疗有良好指导作用。

Objective：To investigate the DSA typing and embolotherapy for hepatocarcinoma with arteriovenous shunt.Methods： Thirty-two cases of hepatocarcinoma with arteriovenous shunt were divided into high-speed type,slow-speed type and middle-speed type according to the speed of arteriovenous shunt,and were treated by corresponding material for embolotherapy.Results： There were 6 cases of high-speed type,16 cases of slow-speed type and 10 cases of middle-speed type.Twenty-three cases（72%） were successfully blocked by one operation,4（13%） were blocked in the second operation,3（9%） were not treated by blockage because of the big shunt with cancer embolus of portal vein,2 were treated by partial blockage and embolotherapy because of the dispersed shunts.A total of 20 cases were found to be companied by cancer embolus of portal vein by the examination of DSA,while only 16 were found by ultrasound examination.Conclusion： DSA could accuratly demonstrate cancer embolus and arteriovenous shunt.The typing method is simple and practical,which provides guidance for the treatment of embolotherapy.