海藻酸钠微球栓塞治疗肝细胞癌合并动静脉分流22例近期疗效观察

Transcatheter arterial chemoembolization with sodium alginate microspheres for hepatocellular carcinoma accompanied with arterial venous shunts:observation of short-term effect in 22 cases

目的探讨海藻酸钠微球(KMG)经肝动脉栓塞治疗肝细胞癌(HCC)合并动静脉分流的安全性及近期临床疗效。方法回顾性分析2009年9月—2012年10月应用KMG栓塞治疗的22例HCC合并动静脉分流患者的临床资料,分析其相关不良反应、并发症及肿瘤的近期疗效。结果 22例患者中肝动脉-门静脉分流(APS)18例,肝动-静脉分流(AVS)3例,APS合并AVS 1例;周围型20例,混合型2例;轻度分流5例,中度分流17例。所有患者均成功行瘘口封堵及肿瘤栓塞治疗;术后不良反应包括:发热59.1%(13/22);肝区疼痛72.7%(16/22);恶心呕吐22.7%(5/22),无严重并发症发生;术后1个月左右复查CT或MR见肿瘤活性灶较栓塞前缩小(t=2.286,P=0.033);所有患者并再次行TACE/TAE治疗,术中示10例出现新发APS,2例新发AVS,再次以KMG成功栓塞。结论 KMG栓塞治疗HCC合并动静脉分流安全,近期疗效显著。

Objective To investigate the safety and short- term efficacy of transcatheter arterial embolization with sodium alginate microspheres （KMG） for the treatment of hepatocellular carcinoma （HCC） complicated by arterial venous shunts. Methods During the period from Sep. 2009 to Oct. 2012 at authors＇ hospital, transcatheter arterial embolization with KMG was carried out in 22 patients with HCC complicated by arterial venous shunts. The clinical data were retrospectively analyzed. The occurrence of side- effects, complications and short- term efficacy were analyzed. Results The lesions included arterio- portal shunts （APS, n = 18）, arterio-venous shunts（AVS, n = 3） and APS together with AVS （n = 1）. Peripheral type of HCC was seen in 20 cases, while mixed type in 2 cases. Mild shunt was detected in 5 cases, while moderate shunt was seen in 17 cases. Transcatheter arterial chemoembolization or transcatheter arterial embolization was successfully carried out in all patients. Postoperative adverse effects included fever （n = 13, 59.1%）, pain at hepatic region （n = 16, 72.7% ） and nausea with vomiting （n = 5, 22.7% ）. No severe complications occurred. CT or MR scanning performed at one month after the treatment showed that active tumor size markedly reduced when compared with the size determined before operation （t = 2.286, P = 0.033）. Transeatheter arterial chemoembolization or transcatheter arterial embolization was carried out again in all patients, which showed that newly-developed APS was seen in 10 cases and newly-developed AVS in 2 cases. Transcatheter arterial embolization with KMG had to be employed again in these patients. Conclusion For the treatment of HCC accompanied with arterial venous shunts, transcatheter arterial embolization with KMG is safe with satisfactory short-term effect.