肝癌合并动静脉瘘71例的诊治体会

The clinical significance of intrahepatic arteriovenous shunt in patients with hepatic carcinoma

目的 探讨合并动静脉瘘 (arteriovenousshunt,AVS)的肝癌病人诊治中的特点。方法我院 1996～ 2 0 0 1年间收治 5 38例肝癌病人 ,收集并分析其中AVS 71例的临床资料。结果 全组中71例合并AVS ,其中肝动脉 门静脉瘘 6 1例 ,肝动脉 肝静脉瘘 8例 ,混合型 2例。在 39例中央型肝动脉 门静脉瘘中 ,30例合并门静脉高压症。行介入治疗 84次 ,完成栓塞化学药物治疗 5 1次 (成功率6 1% ) ,术后肝功能衰竭 3例。病人平均生存期 5 8个月。结论 肝癌并动静脉瘘发生率高 ,预后差 ,加重了病人的门静脉高压症状 ,并使肝癌的栓塞化疗变得棘手。

Objective To investigate the clinical features of intrahepatic arteriovenous shunt(AVS) in patients with hepatic carcinoma. Method The clinical data including results of therapy of 538 hepatic carcinoma patients admitted between 1996 and 2001 were retrospectively reviewed. Results There were 71 cases of AVS altogether with 61 cases of arterio-portal shunt and 8 cases of hepatic arterio-venous shunt. Thirty out of 39 AVS cases with fistula formed between hepatic artery and main portal branch developed portal hypertension. The patients received a total of 84 sessions of transarterial chemotherapy and embolization(TACE) with a success rate of 61%(51 sessions).After TACE liver failure ensued in 3 cases. The mean survival time of these patients was 5.77 months. Conclusion Arterio-portal/venous fistula is a common complication among hepatic carcinoma patients which often predicts poor prognosis. A high percentage of AVS patients will not tolerate TACE and in which the portal hypertension will be exacerbated.