肝癌合并肝动-静脉瘘DSA表现及其与门脉高压间的关系  

DSA features of hepatic arteriovenous fistula concurrent with hepatic cancer and the relationship with portal hypertension

作　　者：陈毓秀[1] 李广琪[1] 张洪新[2] 康军[1] 

机构地区：[1]武警陕西总队医院,陕西西安710054 [2]第四军医大学唐都医院介入放射科,陕西西安710038

出　　处：《现代肿瘤医学》2009年第12期2384-2387,共4页Journal of Modern Oncology

摘　　要：目的:研究肝癌中肝动-静脉瘘的发病率、分型、发生部位以及与肝癌类型、肿瘤血供和门脉高压之间的关系。方法:110例选自我科1989-1999年间收治的经临床和影像资料证实的583例肝癌患者。均采用Seldinger技术行DSA检查证实为肝动-静脉瘘。其中男102例,女8例,年龄27-70岁,平均48.5岁。原发性肝癌103例,转移性肝癌7例(其中原发结肠癌3例,壶腹癌2例,胰腺癌1例,贲门癌1例);合并腹水58例,上消化道出血31例。行纤维胃镜检查33例,上消化道钡餐检查30例。结果:肝癌中肝动-静脉瘘平均发生率为18.9%。肝动-静脉瘘多发生于多血供、巨块型、原发性肝癌(发生率分别为80.9%、62.7%、93.6%)。肝动-静脉瘘中103例为单纯型,占93.6%,表现为:肝动脉-门静脉瘘97例(88.2%),肝动脉-肝静脉瘘4例,肝动脉-下腔静脉瘘2例。7例复杂型表现为:同时存在肝动脉-门静脉瘘、肝动脉-下腔静脉瘘3例,肝动脉-下腔静脉瘘、肝动脉-肝静脉瘘1例,先肝动脉-门静脉瘘,后肝动脉-下腔静脉瘘1例,先肝动脉-下腔静脉瘘、后肝动脉-门静脉瘘1例,3处肝动脉-门静脉瘘1例。按肝动-静脉瘘发生部位分型:周围型95例(86.4%),中央型15例(13.6%)。上消化道钡餐和纤维胃镜对合并腹水和上消道出血病例的检查结果显示:纤维胃镜对食管静脉曲张的阳性检出率明显高于上消化道钡餐检查。结论:肝动-静脉瘘在肝癌中的发生率较高。其中原发性肝癌明显高于转移性肝癌。肝动-静脉瘘多发于巨块型、多血供肝癌,常提示病变的严重程度;肝动-门静脉瘘可能是中晚期肝癌顽固性门脉高压的重要原因之一。肝动-静脉瘘引起的门脉高压中,临床表现腹水为主,出血次之。纤维胃镜对食管静脉曲张的阳性检出率明显高于上消化道钡餐检查。DSA应做为合并门脉高压肝癌患者的常规检查。肝动脉栓塞可阻断肝动-静脉瘘,缓解门脉高压所致腹水�Objective ： To investigate incidence rate of hepatic arteriovenous fistula （ HA - V） among patients with hepatic cancer,its typing and the relationship with types of hepatic cancer and portal hypertension. Methods：Totel of 110 eases were selected from 583 cases of hepatic cancer verified clinically and by radiological images. All 110 cases were verified as hepatic arteriovenous fistula by seldinger technique with DSA, 102 males and 8 females aged between 27 and 70 （ average 48.5 ）, 103 cases were primary and 7 were metastatic. The latter including 3 cases of primary carcinoma of colon ,2 carcinoma of ampulla, 1 carcinoma of pancreas and 1 cardiac cancer. Besides ,there were 58 cases of concurrent aseites and 31 cases of hemorrhage of upper digestive tract ,33 were taken gastrofiberscopy and 30 were taken barium meal check of upper digestive tract. Results： Incidence rate of hepatic arteriovenous fistula among patients with hepatic cancer was 18.9%. Hepatic arteriovenous fistula usually occurs in patients with sufficient blood supply,massive and primary types of hepatic cancer with incidence rates 80.9% , 62.7% and 93.6% respectively. Among the 110 hepatic arteriovenous fistula cases, 103 were simple type, accounting for 93.6% , and with 97 cases of hepatic arterio -pylic fistula （ HA - PV） （88.2%） ,4 hepatic arteriovenous fistula and 2 fistula of hepatic artery and inferior vena cava （ HA - IVC）. Seven cases were complicated type and with 3 cases of hepatic arterio - pylic fistula coexisting with fistula of hepatic artery and inferior vena cava, 1 fistula of hepatic artery and inferior vena cava coexisting with hepatic arteriovenous fistula, 1 hepatic arterio - pylic fistula followed by fistula of hepatic artery and inferior vena cava, 1 fistula of hepatic artery and inferior vena cava followed by hepatic arterio - pylic fistula and 1 fistula of hepatic -pylic at 3 different locations one after another. According to the locations of the fistula,the 110 cases can be divided into two

关 键 词：肝肿瘤 肝动静脉瘘 门脉高压 血管造影数字减影 

分 类 号：R735.7[医药卫生—肿瘤]