肝细胞癌合并周围型动-门静脉瘘介入治疗方案及效果

Interventional treatment and effects of hepatocellular carcinoma with peripheral artery-portal fistula

目的探讨肝细胞癌合并周围型动-门静脉瘘(artery-portal fistula,APF)介入治疗方案及效果。方法选取2009年8月至2016年9月于首都医科大学附属北京地坛医院诊治的肝细胞癌合并周围型动-门静脉瘘(artery-portal fistula,APF)患者82例为研究对象。所有患者均经肝动脉化学栓塞(transcatheter arterial chemoembolization,TACE)治疗,根据术中造影显示的分流量选择1~2种栓塞剂,常用的栓塞剂为碘化油、罂粟乙碘油、明胶海绵颗粒栓塞剂(1400~2000μm),均用洛铂稀释后化疗灌注,观察并比较患者治疗后的疗效。结果介入治疗前合并食管胃底静脉曲张者51例,中度至重度腹水者30例,门静脉癌栓者41例,治疗后11例患者腹水症状消失,17例患者腹水明显减少。65例(79.3%)患者APF瘘口术后完全消失,11例(13.4%)瘘口部分闭合,15例患者术后继续治疗中发现APF瘘口再次复发,11例患者出现新的APF。52例(63.4%)患者肿瘤明显缩小,19例(23.3%)肿瘤增大,11例(13.4%)肿瘤无明显变化。术前59例甲胎蛋白阳性患者介入治疗后41例甲胎蛋白水平下降。术后有4例患者出现上消化道出血。随访中61例病死患者的中位生存期为11.4个月。结论对于肝细胞癌合并周围型APF患者,应根据不同分流量选择合理的栓塞剂,可有效缓解患者临床症状并提高生活质量,最大程度降低术后并发症。

Objective To investigate the effects of interventional therapy for hepatocellular carcinoma with peripheral artery-portal fistula(APF).Methods Total of 82 hepatocellular carcinoma patients with arteryportal fistula in Beijing Ditan Hospital,Capital Medical University from August 2009 to September 2016 were selected.All patients were given transcatheter arterial chemoembolization(TACE)therapy.According to the different flow rate showed by intraoperative angiography,1~2 kinds of embolization agents were selected.Common embolic agents included lipidol,ethiodized poppyseed oil and spongia gelatinosa particle(1400~2000μm).The effects after treatment were compared.Results Before treatment,51 cases were with esophageal gastric varices,30 cases were with moderate to large ascites,and 41 cases were with portal vein tumor thrombus.After treatment,the ascites symptoms disappeared in 11 cases and significantly decreased in 17 cases.There were 11(13.4%)cases whose fistula was partially closed,15 patients whose shunts reopened in later therapy and 11 patients emerged new shunts.There were 52(63.4%)cases whose tumors volume decreased,19(23.3%)cases whose tumors volume increased and 11(13.4%)cases whose tumors volume had no significant change.Before treatment,there were 59 cases with positive alpha fetoprotein(AFP),and after treatment,the levels of AFP in 41 patients decreased.Total of 4 cases occurred postoperative upper gastrointestinal bleeding.The median survival period of 61 patients with death during follow-up was 11.4 months.Conclusion For hepatocellular carcinoma patients with peripheral artery-portal fistula,different embolic agents should be selected according to flow rate so as to relieve the clinical symptoms,and to improve the quality of life and reduce the postoperative complications of the patients.