明胶海绵栓塞肝癌合并动静脉瘘28例分析

目的观察明胶海绵对原发性肝癌合并动静脉瘘栓塞治疗的疗效.方法对28例原发性肝癌合并动静脉瘘患者,行超选择插管造影明确瘘口类型、分流量及肿瘤血供后,对瘘口进行堵塞,并行肿瘤化疗栓塞治疗（TACE）.闭塞瘘口材料主要用明胶海绵.结果28例中23例一次性瘘口堵塞成功（其中21例同时行肿瘤血供动脉栓塞）,5例因瘘口大未能完全封堵.在后续介入治疗中发现,原瘘口封堵成功23例中13例瘘口重新开通或有新的瘘口出现,其中8例作再次封堵均成功.结论超选择插管用明胶海绵对原发性肝癌动静脉瘘的栓塞治疗是一种安全、有效、并发症少的方法,能为肝癌的进一步治疗创造机会.

Objective To explore the strategy of gelfoam in primary hepatocellular carcinoma（HCC）with hepatic arteryportal shunting（APS）interventional embolization treatment method and the curative effect. Methods 28 cases who were HCC combined with APS were collected in the study. The details of shunting and tumor feeding vessel were evaluated by superselective angiography and both blocking up fistula and chemoembolization treatment were carried out. The shunting were blocked with different specifications of the gelfoam. Results 23 shunts were completely closed successfully. 5 shunts were partly closed .21 cases had successful tumor embolization. In 13 patients,the shunts reopened or new shunt emerged in later therapy, and 8 of them were closed after second embolization. Conclusion Superselective embolization with gelfoam at the shunt is safe,effective and full of little complications to the therapy of hepatic arteryportal shunts resulted from primary liver cancer.It can create opportunities for further treatment for hepatocellular carcinoma.