原发性肝癌合并动静脉瘘201例介入治疗

目的通过对肝癌动静脉瘘的数字减影血管造影表现分析,寻找与其相适应的瘘口处理方法,改善肝癌合并动静瘘疗效。方法肝癌合并动静脉瘘201例中,轻度者在碘油栓塞后进行供血动脉明胶海绵栓塞;中度者先行瘘口处理,再行药物灌注与碘油栓塞;重度者试行越过瘘口给药与碘油栓塞3例,行瘘口封堵后药物灌注或单纯药物灌注16例。结果轻度97例动静脉瘘均能得到较满意的碘油沉积后,成功行肿瘤供血动脉的栓塞;中度85例瘘口封堵后碘油得到良好或较好沉积;重度19例中3例越过瘘口的药物与碘油灌注碘油沉积较满意,11例先行封堵后药物加碘油灌注7例沉积较满意,5例瘘口过大或瘘口过于弥漫未能成功封堵,单纯药物灌注。未发生严重并发症。3、6、12、24个月的生存率分别为99.12%、82.30%、68.14%、18.58%。结论肝癌动静脉瘘行合理瘘口封堵可明显改善治疗效果,延长患者生存时间,对瘘口的栓塞处理是安全可靠的。

The interventional therapy of primary hepatocellular carcinoma complicated with arteriovenous fistula

Objective To By analyzing the DSA performance of hepatocellular carcinoma with arteriovenous （A- V） fistula, in search for suitable management of the fistula, and improving the efficacy of hepatocellular carcinoma with A- V fistula Methods Of 201 patients who suffered from hepatocellular carcinoma complicated with A- V fistula, patients with mild A- V fistula were given with gelatin sponge embolization of supplying artery after the lipiodol embolization; patients with moderate A- V fistula treated the fistula firstly, then carried on the medical infusion and the lipiodol embolization. And in 19 patients with severe A- V fistula, 3 patients of them were given by medical and lipiodol embolization blocking off the fistula. after getting across the fistula. The other 16 patients received the medical infusion after Results The embolizations of tumor supplying artery were performed successfully for 97 patients with mild A- V fistula after getting satisfactory results of lipiodol deposits. 85 patients with moderate A- V fistula got better deposit results after blocking off the fistula. In 19 patients with severe A- V fistula, 3 patients got well results by carrying on medical and lipiodol embolization after across the fistula. While in 11 patients who blocking off the fistula firstly plus lipiodol infusion, 7 patients got satisfactory deposit. 5 patients failed in blocking because of large, diffused fistula, and were given single medical embolization simultaneously. No serious complications occurred. The 3 - month, 6- month, 1 - year, 2- year survival rates were 99. 12%, 82.30%, 68. 14% and 18.58% , respectively. Conclusion Reasonable blocking of Hepatocellular Carcinoma with A- V fistula, can improve the efficacy of hepatocellular carcinoma with A- V fistula obviously, and prolong patients＇ survival time. At the same time, it is safe and reliable for management the fistula embolization.