38例原发性肝癌动-静脉瘘介入治疗的疗效分析  

Evaluation of interventional therapy for hepatocellular carcinoma with arteriovenous fistulas： an analysis of 38 cases

作　　者：罗小平[1] 淦伟[1] 

机构地区：[1]重庆医科大学附属第二医院放射科,400010

出　　处：《中华肝脏病杂志》2007年第5期358-361,共4页Chinese Journal of Hepatology

摘　　要：目的回顾性评价超选择性动脉插管栓塞原发性肝癌合并动-静脉瘘的疗效,以期提高患者的生存质量和延长生存期。方法本院近2年实施经动脉插管栓塞化疗的原发性肝癌425例,其中合并动-静脉瘘38例,采用超选择性动脉插管分别对动-静脉瘘以无水乙醇或无水乙醇＋明胶海绵颗粒、对肿瘤病灶以无水乙醇＋碘油（1：1）或碘油＋2～3种化疗药物实施栓塞。观察术后的临床表现,并随访复发率与生存率。结果425例原发性肝癌合并动脉-门静脉瘘38例（8．9％）,其中,高流量型21例（55％）,低流量型17例（45％）,同时伴有肝动脉-肝静脉瘘8例（21％）。38例均成功实施动-静脉瘘及肿瘤病灶的超选择性动脉插管栓塞术,其中,35例经过2～3次治疗。术后肝功能好转23例（61％）;腹水消失13例（34％）,腹水明显减少20例（53％）;6个月生存率84％（32例）,1年生存率61％（23例）。结论超选择性动脉插管栓塞术治疗肝癌伴动-静脉瘘,能缓解其导致的门静脉高压及其严重后果,疗效肯定,并且为同期实施的肿瘤病灶栓塞治疗奠定了基础,该方法可明显提高患者的生存质量,延长生存期。Objective To evaluate the therapeutical effects and techniques of superselective arterial embolization in hepatocellular carcinoma （HCC） patients with arteriovenous fistulas （AVFs）. Methods Data from 425 cases of HCC patients treated with transcatheter arterial chemoembolization （TACE） in our hospital during the last 2 years were analyzed. Ethanol and/or ethanol and gelfoam （into AVFs）, ethanol and/or lipiodol （1 ： 1） or lipiodol and 2 to 3 other kinds of chemodrugs （into tumors） were used to do the transcatheter superselective arterial embolization. Results AVFs were found in 38 of our 425 HCC cases （8.9%）. Among those 38 cases, 21 （55%） had high flux APFs and 17（45%） had low flux APFs. Eight patients （21% of the 38） had both AVFs and hepatic artery-hepatic venous fistulas. AVFs and tumors of the 38 cases were successfully superselectively embolized, but 35 of the 38 cases had 2-3 procedures. After treatment, hepatic functions improved in 23 cases （61%）, ascites disappeared in 13 cases （32%） and ascites decreased in 20 cases （53%）. The survival rates at 6 months and 1 year were 84% （32/38） and 61% （23/38）. Conclusion Superselective embolization procedure is beneficial in relieving portal high pressure and its serious consequences in HCC patients with APFs; it is also a foundation for TACE. The procedure can improve the quality of life and the survival rate of the patients.

关 键 词：癌 肝细胞 治疗学 动-静脉瘘 介入治疗 

分 类 号：R686[医药卫生—骨科学]