栓塞肝动脉-门静脉瘘在TACE联合门静脉支架治疗肝癌伴门静脉癌栓中的临床意义  

Embolization of hepatic arterio-portal shunt in patients with HCC complicated by portal vein tumor thrombus treated with TACE combined with portal vein stenting: its clinical significance

作　　者：钱晟[1] 刘嵘[1] 王建华[1] 颜志平[1] 罗剑钧[1] 龚高全[1] 刘清欣[1] 瞿旭东[1] 程洁敏[1] 

机构地区：[1]复旦大学附属中山医院介入治疗科,上海200032

出　　处：《介入放射学杂志》2015年第4期306-310,共5页Journal of Interventional Radiology

摘　　要：目的评价肝动脉-门静脉瘘(APVS)栓塞对肝癌伴门静脉主干癌栓(MPVTT)患者采用肝动脉化疗栓塞(TACE)联合门静脉支架治疗中的临床意义。方法 26例肝癌伴MPVTT且有明显APVS行TACE联合门静脉支架治疗的患者,采用经皮穿肝门静脉支架植入,门静脉支架植入后使用合适栓塞剂对APVS所属的肝动脉分支进行栓塞。分别于门静脉支架植入前、植入后以及APVS栓塞后行门静脉造影并测量门静脉压力。结果所有患者门静脉支架植入和APVS栓塞均获得成功。支架植入前肝动脉和门静脉造影显示16例患者门静脉为双相血流,10例为离肝血流。16例门静脉双相血流患者14例门静脉支架植入后门静脉向肝血流明显恢复,2例门静脉双相血流和10例离肝血流患者APVS栓塞后门静脉主干向肝血流恢复。支架植入前、后以及APVS栓塞后门静脉压力分别为(50.1±6.3)cm H2O、(43.5±7.5)cm H2O和(36.9±8.2)cm H2O,门静脉支架植入后门静脉压力较支架植入前明显下降,差异有统计学意义(P<0.05),APVS栓塞后门静脉压力较门静脉支架植入后进一步下降(P<0.05)。结论对肝癌伴MPVTT和明显APVS患者,植入门静脉支架能有效复通门静脉血流,降低门静脉压力;APVS栓塞则进一步降低门静脉压力,从血液动力上使门静脉双相或离肝血流恢复为向肝血流。Objective To evaluated the clinical significance of embolization of arterio- portal venous shunt（APVS） in hepatocellular carcinoma（HCC） patients with main portal vein tumor thrombus（MPVTT）treated by transcatheter arterial chemoembolization（TACE） and portal vein stenting. Methods Twenty- six HCC patients with MPVTT and marked APVS, who were treated with TACE and portal vein stenting, were enrolled in this study. Portal vein stenting was performed via percutaneous transhepatic approach, which was followed by the embolization of the feeding arteries of APVS by using suitable embolic agents. The portal vein pressure levels were separately measured before, after portal vein stenting and after APVS embolization. The results were statistically analyzed. Results Both the portal vein stenting and APVS embolization were successfully accomplished in all the 26 patients. Hepatic angiography and portal venography performed before portal vein stenting revealed bidirectional portal flow in 16 cases and hepatofugal portal flow in 10 cases.Among the 16 patients with bidirectional portal flow, remarkable improvement of portal vein to liver blood flow after portal vein stenting was seen in 14, and obvious recovery of main portal vein to liver blood flow after APVS embolization in 2. Obvious recovery of main portal vein to liver blood flow after APVS embolization was also demonstrated in 10 cases with hepatofugal portal flow. The portal vein pressure determined before, after portal vein stenting and after APVS embolization was（50.1 ±6.3） cm H2 O,（43.5 ±7.5） cm H2 O and（36.9 ±8.2） cm H2 O respectively. After portal vein stenting the portal vein pressure was significantly decreased when compared with the preoperative pressure, and the difference was statistically significant（P〈0.05）; after APVS embolization the portal vein pressure was further decreased（P〈0.05）.Conclusion For HCC patients with MPVTT and marked APVS, portal vein stenting can effectively restore the portal blood flow and reduce

关 键 词：癌 肝细胞 门静脉主干癌栓 动-门静脉瘘 支架 栓塞 

分 类 号：R735.7[医药卫生—肿瘤]