肝癌并肝动-静脉瘘介入治疗长期疗效分析——附14例报道

Investigation on the Long-period Curative Effect of Intervention on Treating Hepatocellular Carcinoma Complicated with Hepatic Arteriovenous Shunt

目的 :探讨肝癌并肝动 -静脉瘘 ( AVS)经肝动脉化疗栓塞 ( TACE)的可行性。方法 :对 1 4例患者行经股动脉送入 5 F导管至肿瘤供血动脉 ,试探性注入碘油 1 ml,密切观察病人有无咳嗽、气促等反应 ,并视病人反应不同将其分为 A、B两组。 A组患者瘘口较小 ,可先行碘化疗栓塞 ,而后行明胶海棉栓塞 ;B组患者瘘口较大 ,需先行明胶海棉栓塞 ,再行碘化疗栓塞。结果 :1 4例造影均在动脉期肝静脉提前显影 ,其中肝右静脉 9例 ,肝中静脉 3例 ,肝左静脉 2例。A组平均生存期 1 4个月 ;B组平均生存期 9.6个月。术中及围手术期未出现严重并发症。结论 :尽管肝癌合并 AVS曾被认为是 TACE的禁忌症 ,只要医生对其特殊性和复杂性有清楚地认识 ,在操作中根据病人反应而做出相应处理 ,就能取得较好的疗效而不出现严重并发症。瘘口较小者经肝动脉化疗栓塞后其疗效较好 ,瘘口较大者疗效不够理想。

Objective: To study the feasibility of treating hepatocellular carcinoma(HCC) complicated with hepatic arteriovenous shunt(AVS) by transcatheter arterial chemo embolization(TACE).Methods:14 patients diagnosed as HCC were treated by HCC.The patients were closely observed on their reaction during the TACE, and were devided into group A(without cough) and B(with cough)according the reaction. The lipiodle embolization was taken before the sponge embolization on the patients in group A,while the sponge embolization was taken before the lipiodle embolization on the patients in group B.Results: On angiography, hepatic vein was found in all 14 cases at arterial phase,with 9 cases in right hepatic vein,3 cases in center hepatic vein and 2 cases in left hepatic vein. Mean survival periods in group A and B were 14,9.6months respectively. There were no complication appearing during and after TACE. Conclusion:TACE can get a better curative effect without serious complication on HCC with AVS as long as doctors keep a close watch on patients' reaction and select the corresponding measure.It is more effective on group A than on Group B.