肝癌合并动-静脉分流一种DSA新分型法的临床应用  

Clinical Application of a New DSA Typing in the Embolotherapy for Hepatocarcinoma with Arteriovenous Shunting

作　　者：宋锦文[1] 杨艳[1] 刘晓红[1] 王志宏[1] 印建国[1] 李中华[1] 贾雄[1] 白庚申[1] 

机构地区：[1]兰州军区兰州总医院放射科,甘肃省兰州市730050

出　　处：《临床放射学杂志》2012年第8期1156-1159,共4页Journal of Clinical Radiology

摘　　要：目的探讨并总结肝癌合并动-静脉分流的DSA表现和以分流速度为基础的新分型方法及其在栓塞治疗中的临床意义。方法根据分流速度将中晚期肝癌动-静脉分流分为3型,即:快速型、慢速型和中速型。对32例肝癌合并动-静脉分流患者经DSA检查进行分型,选择相应的栓塞材料进行栓塞封堵治疗。结果 32例中,快速型6例(19%),慢速型16例(50%),中速型10例(31%)。23例(72%)一次封堵成功,4例(13%)二次封堵瘘口消失,3例(9%)因分流口较大,同时伴有门静脉癌栓,未行封堵,2例(6%)因分流口较多且分散仅行部分分流口封堵及栓塞化疗。32例中20例DSA同时显示合并门静脉癌栓(与CT所示相符),超声仅检出16例;栓塞治疗后患者临床症状均有不同程度改善。结论中晚期肝癌患者栓塞术前DSA检查可准确显示动-静脉分流和癌栓情况,以分流速度快慢为依据的分型法简便、实用,在栓塞治疗中有重要的临床意义。Objective To explore the appearances of hepatocarcinoma accompanied with arteriovenous shunting and to assess the application of a new typing method in guiding embolotherapy.Methods 32 cases of primary hepatocarcinoma with arteriovenous shunting were divided into high speed type,slow-speed type and middle-speed type according to the speed of arteriovenous shunting in the examination of DSA.All the patients were treated by corresponding material for embolotherapy.Results Six cases were high-speed type（19%）,16 were slow-speed type（50%） and 10 were middle-speed type（31%）.23 patients（72%） were successfully blocked by once operation,4 patients（13%） were blocked by twice operation.3 cases（9%） were not successfully blocked because of the big shunting with portal vein cancer embolus.2 cases were partially blocked and embolotherapy because of the multiple and dispersed shunting.20 cases had portal vein cancer embolus on DSA images.All clinical syndromes were improved after therapy.Conclusion DSA is good at showing arteriovenous shunting and cancer embolus.The ＂speed-typing＂ method is simple and practical,which provides guidance for the treatment of embolotherapy.

关 键 词：肝癌 动-静脉分流 数字减影 血管造影术 临床应用 

分 类 号：R735.7[医药卫生—肿瘤]