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目的 :探讨中晚期原发性肝癌合并动静脉瘘 (AVS)的形成机制、DSA表现及其临床意义。方法 :回顾性分析172例中晚期原发性肝癌合并AVS48例 (2 7.9% )。分析其DSA表现 ,按其类型、位置、及AVS出现时间的早迟分为不同类别。 39例经导管化疗栓塞 (TAE) ,9例行单纯灌注 (TAI)。结果 :48例AVS表现者中 ,2 6例获完全缓解 (CR)或部分缓解(PR) ,中位生存时间为 8个月。其 2月、6月、1年、2年累积生存率分别为 70 .8%、46 .7%、14.0 %、10 .0 %。 36例轻中度AVS ,2 4获CR或PR ,中位生存时间 11月 ,明显长于重度AVS(4月 ) (P <0 .0 1)。TAE有效率 6 4.1% ,TAI组为11.1% ,两组间有显著差异 (P <0 .0 1)。周围型有效率 85 .0 %明显高于中央型 2 9.2 %。 10例出现肝功能衰竭 ,4例并发消化道大出血。结论 :DSA能直接而全面显示AVS类型、部位及程度 ,为治疗及预后提供重要参考价值 ,对轻中度AVS ,TAE安全有效 ,而对重度AVS ,TAE易致严重并发症。
Objective : To investigate the formation mechanism, DSA manifestation and clinical significance of advanced hepatocellular carcinoma combined with arteriovenous fistula (AVS). Methods: Retrospective analysis of 172 patients with advanced primary liver cancer combined with AVS (2 7.9%). Analyze its DSA performance and classify it according to its type, location, and time of early appearance of AVS. Thirty-nine patients underwent transcatheter chemoembolization (TAE) and 9 patients underwent simple perfusion (TAI). Results Among the 48 AVS performers, 26 had complete remission (CR) or partial remission (PR), with a median survival of 8 months. The cumulative survival rates in February, June, 1 year, and 2 years were 70.8%, 46.7%, 14.0%, and 10.0%, respectively. 36 patients with mild to moderate AVS, 24 with CR or PR, median survival time of 11 months, significantly longer than severe AVS (4 months) (P < 0.01). The TAE effective rate was 4.1% and the TAI group was 11.1%. There was a significant difference between the two groups (P < 0.01). The efficiency of peripheral type 85.0% is significantly higher than that of central type 29.2%. Liver failure occurred in 10 cases, and gastrointestinal hemorrhage occurred in 4 cases. Conclusion : DSA can directly and comprehensively display the type, location and extent of AVS, providing important reference value for treatment and prognosis. It is safe and effective for mild to moderate AVS and TAE, and severe complications for severe AVS and TAE.