肝癌合并动静脉瘘的处理方法探讨

目的：研究肝癌介入治疗中对肝癌合并肝动脉肝静脉瘘和肝动脉门静脉瘘的处理方法。方法：对5例肝动脉肝静脉瘘患者（A组）先行在瘘口附近多点，多次的经皮无水酒精注射消融术（PEI）后，再行经导管肝动脉栓塞术（TAE）。对26例肝动脉门静脉瘘者（B组）则将超微导管头端越过瘘口后进行栓塞，再用带毛钢圈或无水乙封闭瘘田，结果：A组动脉脉瘘消失及明显减少40例，无效10例。在消融后TAE碘油沉积良好的38例中，37例PEI在4次以上，B组26例经1－2次治疗后，全部达到中止门静脉分流的目的，表现为TAE碘油沉积良好25例，门静脉压力明显下降，其中腹力减水23例，上消化道出血的2例均于术后1d止血。结论：上述2种方法处理肝癌合并动脉脉瘘后，能令碘油药物更好地在肿瘤内沉积，避免或减少了碘油导致肺梗死或门静脉压力进一步升高的危险性，提高了肝癌介入治疗的效果。

The management of arteriovenous shunting in hepatocellular carcinoma

Objective To investigate the management of arteriovenous shunting (AVS) within the liver in interventional therapy for hepatocellular carcinoma (HCC). Methods Fifty cases with hepatic arteriovenous shunting(Group A)were treated with percutaneous ethanol ablation (PEI) near the orifice in the mode of multi-point repeated injection before the transcatheter arterial embolization (TAE). For the 26 cases with arterioportal venous shunting (APVS) (Group B), the TAE was done firstly while the tip of the microcatheter passed beyond the site of APVS and followed by the Cook-coil or ethanol to block the orifice. Results The shunting disappeared or marked reduced in 40 cases in Group A, and no change in 10 cases. Of the 38 cases, their iodized oil deposition was satisfactory after TAE. PEI was done more than 4 times in 37 casses. The APVS was controlled in all the 26 cases in Group B after embolization for 1-2 times. Of these patient, a good iodized oil deposition was achieved in 25 cases, the pressure of portal vein was markedly decreased with the reduction of ascites in 23 cases, and the bleeding of upper gastrointestine was ceased in 2 cases on the following day after the management. Conclusion The two methods used in the management of AVS can get a better iodized oil deposition in the tumor, reduce the risk of pulmonary oil embolism or the increase of pressure of portal vein, and improve the effect of the interventional therapy for HCC.