肝癌肝动脉-门静脉瘘并消化道出血的介入治疗  

Interventional treatment of upper gastrointestinal bleeding in patients of hepatic carcinoma accompanied with hepatic artery-portal vein shunting

作　　者：李继军 尚建强 刘作勤 唐军 孙增涛 陈颉 张垒 刘洪军[2] 周召海[2] 

机构地区：[1]山东省医学影像研究所介入科,济南250021 [2]山东省平度市人民医院放射科

出　　处：《介入放射学杂志》2011年第2期120-122,共3页Journal of Interventional Radiology

摘　　要：目的研究肝癌合并肝动脉-门静脉瘘(HAPVS)患者因门静脉压力升高导致上消化道出血的诊断和介入治疗。方法回顾性分析27例肝癌合并上消化道出血患者的临床资料,本组患者均行肝动脉造影检查及肝动脉栓塞术,并对不同类型的HAPVS分别或联合使用弹簧钢圈、明胶海绵条或PVA颗粒行瘘口栓塞术。结果本组27例中16例为中央型肝动脉-门静脉瘘、11例为周围型;20例为逆肝血流;23例伴有腹水。栓塞术后,本组病例瘘口全部一次封堵成功,术后1～2 d内消化道出血停止。1个月后再次行DSA检查,见肝动脉-门静脉瘘消失。16例腹水消失,7例腹水减少。上消化道出血症状未复发。结论肝动脉-门静脉瘘是肝癌患者出现上消化道出血的重要原因,肝动脉DSA检查可明确诊断,瘘口栓塞术是目前治疗肝癌肝动脉-门静脉瘘合并上消化道出血的安全有效的方法。Objective To explore the diagnostic and therapeutic efficacy of interventional procedure for upper gastrointestinal bleeding in patients of hepatic carcinoma accompanied with hepatic artery-portal vein shunting（HAPVS）.Methods Clinical data of 27 patients of hepatic carcinoma accompanied with HAPVS were retrospectively analyzed.All patients underwent hepatic arterial angiography and transcatheter arterial embolization.Shunts were embolized with coils,Gelfoam particles or PVA particles.Results Of 27 patients with upper gastrointestinal bleeding,central type HAPVS was seen in 16 and peripheral type HAPVS in 11.Reversed portal venous flow was detected in 20 cases and ascites was found in 23 cases.The abnormal shunts were successfully occluded in all patients and the bleeding ceased within 2 days after embolization.No recurrent bleeding occurred in one month after the treatment.Ascites disappeared in 16 cases and subsided in 7 cases.Conclusion HAPVS is an important cause for upper gastrointestinal bleeding in patients of hepatic carcinoma,and the arteriovenous fistula can be confirmed with hepatic artery DSA.Embolization of fistulous orifice is the most effective therapy for such patients.

关 键 词：肝癌 动静脉瘘 出血 栓塞 

分 类 号：R735.7[医药卫生—肿瘤]