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[目的]评估经肝动脉导管内注射明胶海绵浆—化疗药物碘油乳剂(复合型栓塞剂)治疗肝癌合并高流量动静脉瘘(arterio-venous shunting,AVS)的疗效。[方法]共有98例合并高流量AVS肝癌患者施行瘘口封堵术。按照患者意愿进行分组,治疗组(n=36)采用复合型栓塞剂封堵瘘口,再行经导管动脉内化疗栓塞术(transcatheter arterial chemoembolization,TACE)。对照组(n=62例)采用单纯明胶海绵颗粒封堵瘘口,再酌情行TACE术。术后观察两组患者严重不良反应、瘘口完全闭塞率、再通率、近期疗效以及生存率。[结果]治疗组和对照组AVS完全闭塞率分别为100%、80%,瘘口再通率为10%、60%,肿瘤近期疗效80%、50%,6、12、24个月生存率90%、75%、30%和80%、50%、10%,均具有统计学差异,P<0.05。两组患者未发生严重感染、肝功能衰竭、消化道出血、肺梗死、手术相关死亡等严重不良反应。[结论]与单纯明胶海绵相比,采用明胶海绵浆—化疗药物碘油乳剂封堵肝癌AVS不仅简便易行,且疗效更确切,从而延长患者生存期。
[Objective] To evaluate the efficacy of intrahepatic arterial catheter injection of gelatin sponge - chemotherapy lipiodol emulsion (composite embolization agent) in the treatment of hepatocellular carcinoma complicated with high-flow arterio-venous shunting (AVS). [Method] A total of 98 patients with high-flow AVS HCC were treated with occlusion of fistula. Patients were divided into groups according to the patients’ wishes. The treatment group (n = 36) was treated with a composite embolization agent to seal the fistula and transcatheter arterial chemoembolization (TACE). Control group (n = 62 cases) using simple gelatin sponge particles occlusion fistula, and then under the line of TACE surgery. Two groups of patients were observed after serious adverse reactions, complete occlusion rate, recanalization rate, short-term efficacy and survival rate. [Results] The complete occlusion rates of AVS in treatment group and control group were 100% and 80% respectively, the fistula recanalization rate was 10% and 60%, the short-term effect of tumor was 80%, 50%, 6,12 and 24 months respectively 90%, 75%, 30% and 80%, 50% and 10%, respectively, with statistical significance (P <0.05). Two groups of patients without serious infection, liver failure, gastrointestinal bleeding, pulmonary infarction, surgery-related deaths and other serious adverse reactions. [Conclusion] Compared with the simple gelatin sponge, sealing the AVS of hepatocellular carcinoma with gelatin sponge-chemotaxis lipiodol emulsion is not only simple and easy to operate, but also has a more exact effect, thus prolonging the survival of patients.