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目的研究肝癌合并肝动脉门静脉瘘(HAPVF)时,门静脉压力升高的血液动力学改变,及由此导致的顽固性上消化道出血的诊断和治疗。方法 115例肝癌合并上消化道出血患者行肝动脉造影检查,其中严重 HAPVF 者用钢圈和(或)无水酒精行瘘口栓塞术。结果本组84例一般性的上消化道出血者中,15例有轻度的 HAPVF;31例顽固性上消化道出血肝癌患者中,26例有严重的HAPVF,差异有统计学意义(χ~2=43.01,P<0.01)。对此26例有严重的 HAPVF 患者行栓塞术后,DSA 示血液分流减轻或消失,其中2例肝动脉主干闭塞。26例治疗后上消化道出血均停止。结论肝癌出现顽固性上消化道出血时要考虑到可能有严重的 HAPVF 存在,肝动脉 DSA 可作出诊断。瘘口栓塞术是治疗此类型出血最有效的方法。
Objective To study the hemodynamic changes of portal hypertension and the diagnosis and treatment of intractable upper gastrointestinal bleeding caused by HCC with hepatic arterial fistula (HAPVF). Methods One hundred and fifteen patients with hepatic carcinoma complicated with upper gastrointestinal bleeding underwent hepatic artery angiography. Among them, severe HAPVF was occluded with a steel ring and / or anhydrous alcohol. Results Of the 84 patients with general upper gastrointestinal bleeding, 15 had mild HAPVF. Among the 31 patients with refractory upper gastrointestinal bleeding, 26 had severe HAPVF, the difference was statistically significant (χ ~ 2 = 43.01, P <0.01). In this 26 cases of severe HAPVF patients after embolization, DSA showed reduced or disappeared blood shunt, including two cases of hepatic artery occlusion. 26 cases of upper gastrointestinal bleeding stopped after treatment. Conclusion The occurrence of intractable upper gastrointestinal bleeding in patients with liver cancer should take into account the possible existence of severe HAPVF, hepatic artery DSA can make a diagnosis. Fistula embolization is the most effective method of treatment of this type of bleeding.