氰基丙烯酸酯胶栓塞原发性肝细胞癌合并重度肝动脉门静脉瘘12例疗效分析

Transarterial embolization therapy with cyanoacrylate for severe arterioportal shunt associated with hepatocellular carcinoma

目的评价采用α-氰基丙烯酸正丁酯(N-butyl 2-cyanoacrylate,NBCA)胶栓塞治疗肝癌伴重度肝动脉门静脉瘘(arterioportal shunt,APS)的临床疗效。方法 2006年1月至2010年1月,采用NBCA胶栓塞治疗12例原发性肝细胞癌合并有门静脉主干表现为离肝血流的重度APS患者。随访和分析12例重度APS患者的手术前后APS改善情况、肿瘤反应、生存期和手术相关并发症等。结果接受NBCA胶栓塞的12例患者在术后即刻造影显示APS迅速改善。而在进行随访复查造影的10例中,有8例的APS得到持续改善。按mRECIST标准在首次栓塞术后第4个月肿瘤取得最大疗效;接受随访的病例中部分缓解为2/10,疾病进展为3/10,疾病稳定为5/10。患者的半年、1年和2年的生存率分别为67%,33%,8%;中位生存期为275 d,介入栓塞未出现严重并发症。结论采用NBCA胶栓塞肝癌合并重度APS患者是一种安全有效的治疗方法。

Objective To evaluate the efficacy and safety of embolization therapy by using N-butyl 2cyanoacrylate（NBCA） glue for the treatment of severe arterioportal shunt（APS） that is manifested as hepatofugal portal venous flow in hepatocellular carcinoma（HCC） patients.Methods During the period from January 2006 to January 2010,a total of 14 HCC patients with severe APS,which presented as hepatofugal portal venous flow,underwent transarterial chemo-perfusion and embolization of APS with NBCA glue.Among them,two patients were excluded from the study because they took antitumor medicine（sorafenib） at the same time.The change of APS,tumor response,survival rate and procedure-related complications were analyzed.Results Angiography performed immediately after the embolization therapy with NBCA glue showed that APS was improved rapidly in all the 12 patients.Of the 10 patients who received follow-up examination with angiography,continuous improvement of APS was observed in 8.According to mRECIST criteria,the maximum tumor response was obtained at the fourth month after the initial glue embolization,and at that time the partial response was obtained in 20% of patients（2/10）,progressive disease in 30%（3/ 10） and stable disease in 50%（5/10）.The survival rates at half,one and two years after the treatment were 67%,33% and 8% respectively.The median survival time was 275 days.No severe embolization-related complications occurred.Conclusion The preliminary experience indicates that glue embolization may be an effective and safe therapy for the management of severe arterioportal shunt accompanied by HCC.