肝癌合并动静脉瘘的处理方法探讨  

The management of arteriovenous shunting in hepatocellular carcinoma

作　　者：罗鹏飞[1] 陈晓明[1] 张良明[1] 周泽健[1] 符力[1] 魏志华[1] 

机构地区：[1]广东省人民医院肿瘤科,广州510080

出　　处：《中华放射学杂志》2002年第2期114-117,共4页Chinese Journal of Radiology

摘　　要：目的　研究肝癌介入治疗中对肝癌合并肝动脉肝静脉瘘和肝动脉门静脉瘘的处理方法。方法　对 5 0例肝动脉肝静脉瘘患者 (A组 )先行在瘘口附近多点、多次的经皮无水酒精注射消融术 (PEI)后 ,再行经导管肝动脉栓塞术 (TAE)。对 2 6例肝动脉门静脉瘘者 (B组 )则将超微导管头端越过瘘口后进行栓塞 ,再用带毛钢圈或无水乙醇封闭瘘口。结果　A组动静脉瘘消失及明显减少 40例 ,无效 10例。在消融后TAE碘油沉积良好的 38例中 ,37例PEI在 4次以上。B组 2 6例经 1～ 2次治疗后 ,全部达到中止门静脉分流的目的 ,表现为TAE碘油沉积良好 2 5例 ,门静脉压力明显下降 ,其中腹水减少 2 3例 ,上消化道出血的 2例均于术后 1d止血。结论　上述 2种方法处理肝癌合并动静脉瘘后 ,能令碘油药物更好地在肿瘤内沉积 ,避免或减少了碘油导致肺梗死或门静脉压进一步升高的危险性 。Objective To investigate the management of arteriovenous shunting (AVS) within the liver in interventional therapy for hepatocellular carcinoma (HCC). Methods Fifty cases with hepatic arteriovenous shunting(Group A)were treated with percutaneous ethanol ablation (PEI) near the orifice in the mode of multi-point repeated injection before the transcatheter arterial embolization (TAE). For the 26 cases with arterioportal venous shunting (APVS) (Group B), the TAE was done firstly while the tip of the microcatheter passed beyond the site of APVS and followed by the Cook-coil or ethanol to block the orifice. Results The shunting disappeared or marked reduced in 40 cases in Group A, and no change in 10 cases. Of the 38 cases, their iodized oil deposition was satisfactory after TAE. PEI was done more than 4 times in 37 casses. The APVS was controlled in all the 26 cases in Group B after embolization for 1-2 times. Of these patient, a good iodized oil deposition was achieved in 25 cases, the pressure of portal vein was markedly decreased with the reduction of ascites in 23 cases, and the bleeding of upper gastrointestine was ceased in 2 cases on the following day after the management. Conclusion The two methods used in the management of AVS can get a better iodized oil deposition in the tumor, reduce the risk of pulmonary oil embolism or the increase of pressure of portal vein, and improve the effect of the interventional therapy for HCC.

关 键 词：肝细胞癌 动脉脉瘘 乙醇 治疗性栓塞 治疗 

分 类 号：R735.7[医药卫生—肿瘤] R543[医药卫生—临床医学]