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目的探讨原发性肝癌合并肝动静脉瘘(arteriovenous shunting,AVS)的介入栓塞治疗策略及疗效。资料与方法 39例原发性肝癌合并AVS患者,超选择插管造影明确AVS的类型、分流量及肿瘤血供后,按不同方式进行堵瘘及肿瘤化疗栓塞治疗。术后观察临床症状改善及肿瘤变化,随访生存期3～12个月。结果 37例完成化疗栓塞,2例仅行化疗灌注。首次治疗瘘口消失或分流减少35例,CT显示碘油较好沉积或肿瘤稳定缩小34例。术后大部分顽固性腹腔积液、腹泻及上消化道出血等症状控制或改善,无肺栓塞、肝功能衰竭等并发症。3个月、6个月、12个月生存率分别为94.9%、87.2%、41.0%。结论精细的超选择插管造影及瘘口封堵有助于原发性肝癌合并AVS的大部分栓塞,改善患者临床症状并延长生存时间。
Objective To investigate the interventional embolization strategy and efficacy of primary hepatocellular carcinoma with arteriovenous shunting (AVS). Materials and Methods 39 cases of primary hepatocellular carcinoma with AVS patients, super selective catheterization clear the type of AVS, sub-flow volume and tumor blood supply, according to different ways of fistula and tumor chemoembolization. Postoperative observation of clinical symptoms and tumor changes, follow-up survival of 3 to 12 months. Results 37 cases completed chemotherapy embolization, 2 cases only chemotherapy infusion. The first treatment fistula disappeared or shunt reduced in 35 cases, CT showed that the better deposition of lipiodol or tumor shrinkage in 34 cases. Most postoperative intractable ascites, diarrhea and upper gastrointestinal bleeding and other symptoms control or improvement, no pulmonary embolism, liver failure and other complications. The survival rates at 3 months, 6 months and 12 months were 94.9%, 87.2% and 41.0%, respectively. Conclusion Fine superselective catheterization and occlusion of the fistula contribute to the embolization of primary hepatocellular carcinoma with AVS, improving the clinical symptoms and prolonging the survival time.