原发性肝癌合并肝动脉-门静脉瘘介入治疗分析

目的回顾性分析原发性肝癌合并肝动脉-门静脉瘘介入治疗方法及临床疗效。方法对38例肝癌合并肝动脉-门静脉瘘患者用聚乙烯醇(PVA)颗粒 无水乙醇栓塞动静脉瘘,经DSA造影了解瘘闭塞情况。结果38例中动静脉瘘消失及明显减少31例,动静脉瘘减少不明显或无效7例。4例消化道出血均于术后1天后停止,14例腹水明显减少。28例TAE碘油沉积良好。结论以PVA 无水乙醇栓塞动静脉瘘安全有效,能使碘油药物更好地沉积于肿瘤内,提高了肝癌介入治疗的效果。     

平阳霉素碘化油混合乳剂动脉栓塞在治疗肝血管瘤中的临床应用

目的分析和探讨平阳霉素碘化油混合乳剂(PLE)动脉栓塞在肝血管瘤介入治疗中的临床疗效。方法运用超液态碘化油 明胶海绵颗粒和PLE,对我院42例肝血管瘤患者进行动脉栓塞治疗,其中24例运用PLE进行栓塞治疗,运用PLE时其中6例患者追加明胶海绵颗粒进行栓塞,术后2~6个月观察碘油沉积、肿瘤大小变化及并发症的发生。结果所有病例术前肝动脉造影显示“枝上挂果”“早出晚归”的异常血管湖样改变,栓塞后肿瘤内碘油沉积良好;术后1例出现严重并发症,4例栓塞后无明显效果,其他患者肿瘤均缩小,20例患者肿瘤缩小>50%。结论平阳霉素碘化油混合乳剂动脉栓塞治疗肝血管瘤是一种疗效肯定,安全理想的治疗方法。     

介入栓塞术联合术后注射无水乙醇治疗颌面部动静脉畸形

目的：探讨以数字减影成像显影下血管介入栓塞技术联合术后注射无水乙醇治疗颌面部动静脉畸形的疗效。方法：对6例颌面部动静脉畸形患者行血管介入造影检查,并超选择性插管栓塞供血动脉及病灶,注入聚乙烯醇颗粒、无水乙醇等栓塞剂栓塞畸形血管团,术后根据恢复情况定期在病灶血管腔内注射无水乙醇。结果：6例颌面部动静脉畸形患者均栓塞成功,达到临床治疗目的,无严重并发症发生。结论：血管介入造影下超选择性插管栓塞联合术后无水乙醇是治疗颌面部动静脉畸形的一种有效、安全的方法。     

肝脏膈面生长的外生型肝癌的影像学特点及介入治疗

目的分析肝脏膈面生长的外生型肝癌的影像学特点及介入治疗。方法 5例外生型肝癌根据临床表现、AFP、CT、肝动脉造影及病理确诊;介入治疗采用肝动脉灌注及栓塞术和无水乙醇或碘化油直接注射。结果肝脏膈面生长的外生型肝癌影像学特点为生长于膈面,富血供,多支供血,5例肝脏膈面生长的外生型肝癌经肝动脉灌注化疗及栓塞术,其中3例同时采用无水乙醇或碘化油直接注射治疗,1、2、3年生存率分别为60%、20%、20%。结论肝脏膈面生长的外生型肝癌影像学特点为生长于膈面,富血供,多支供血,介入治疗是一种有效、安全的方法。     

海绵窦区硬脑膜动静脉瘘的血管内栓塞治疗

目的　探讨海绵窦区硬脑膜动静脉瘘的诊治方法。　方法　 3 2例采用微导管超选择性插管 ,将微导管前端送入硬脑膜动静脉瘘瘘口处 ,经微导管造影证实并无危险吻合支 ,然后经微导管注入微粒行瘘的供血动脉及瘘口栓塞 ,其中 12例同时并经岩上、下窦采用钨丝微螺旋圈行海绵窦内栓塞。　结果　 2 8例栓塞后造影瘘口完全闭塞 ,4例栓塞后造影瘘口有少许显影 ,术后采取压迫患侧颈总动脉 ,1周后造影瘘口消失。经 6个月～ 8年的随访未见瘘口再通。　结论　血管内栓塞治疗海绵窦区硬脑膜动静脉瘘是行之有效的方法。     

术中导向化疗与栓塞治疗不能切除的肝癌40例报告

作者用碘化油作载体携带阿霉素和/或丝裂霉素制成乳剂,术中对不能切除的肝癌经肝动脉注入,同时加用明胶海绵栓塞肿瘤近端血管,并结扎肝动脉,离断肝脏部分韧带治疗肝癌40例。近期效果满意,报告如下。     

肝外供血动脉栓塞在巨块型肝癌治疗中的价值

目的探讨经导管肝外供血动脉栓塞在治疗巨块型肝癌中的价值。方法对35例巨块型肝癌,首次行经导管肝动脉化疗栓塞术（TACE）,第2次及其后在肝动脉TACE基础上加行经右侧胸廓内动脉、右侧肋间动脉侧支供血动脉栓塞术。结果本组35例巨块型肝癌患者,发现肝外侧支49支,对46支使用微导管进行栓塞治疗,3支行超选择灌注化疗。初次TACE治疗时肝外血供多有膈下动脉参与,治疗过程中,随着肿瘤的增大或肝动脉的闭塞,胸廓内动脉、肋间动脉、胰十二支肠动脉弓等血管有可能参与。结论对肝外侧支血管应用微导管超选择栓塞或灌注化疗均能加强TACE在巨块型肝癌治疗中的作用,提高患者带瘤生存期。     

急诊经导管动脉栓塞治疗医源性肝动脉出血

目的探讨医源性肝动脉出血的急诊肝动脉造影表现及经导管动脉栓塞(TAE)治疗的疗效。方法对38例医源性肝动脉出血患者行急诊肝动脉造影,确定出血动脉后,以明胶海绵、PVA颗粒和弹簧圈进行急诊栓塞治疗;对其急诊肝动脉造影表现及TAE疗效进行回顾性分析。结果 38例中,21例肝动脉造影可见对比剂外溢,5例肝动静脉瘘,9例肝动脉假性动脉瘤,3例肝动脉假性动脉瘤合并肝动静脉瘘。急诊TAE后38例出血均停止,总有效率为100%(38/38)。1例术后10天复发出血,再次栓塞治疗后出血停止。随访12个月,所有患者均无肝脏坏死及异位栓塞等严重并发症发生。结论急诊TAE治疗医源性肝动脉出血安全、有效。     

莪术油和无水乙醇双介入治疗中晚期肝癌

目的:观察莪术油经肝动脉栓塞加无水乙醇瘤体注射治疗原发性肝癌的疗效。方法:将75例患者分为双介入组(莪术油肝动脉栓塞配合经皮无水乙醇注射疗法)、莪术油组、无水乙醇组,分别采用相应的方法治疗,观察治疗后肿瘤的病灶变化、AFP、肝功能、生存时间及毒副反应。结果:双介入组在近期疗效、生存期及毒副反应等方面优于莪术油介入组和无水乙醇介入组。结论:莪术油经肝动脉栓塞加无水乙醇瘤体注射治疗原发性肝癌的疗效显著,具有一定的临床应用价值。     

国产医用胶在肝动脉出血栓塞中的应用

目的探讨国产医用胶肝动脉出血栓塞的有效性和安全性。方法对17例肝动脉损伤出血患者采用福爱乐医用胶进行栓塞,其中肝癌血管破裂出血2例,医源性出血5例,外伤性出血10例。对所有患者均在造影明确出血部位后予以微导管超选择插管至出血部位,经微导管注入福爱乐医用胶+碘化油混合液(比例为1∶1)进行栓塞。结果造影发现17例患者中3例对比剂外溢,6例为假性动脉瘤,6例为肝动静脉瘘,2例肝动静脉瘘合并假性动脉瘤。17例患者均成功栓塞,手术成功率100%(17/17),福爱乐医用胶与超液化碘油混合物用量0.3~1.1ml,中位数0.60ml,栓塞所用时间11~23min,中位时间15min,栓塞所耗医用胶费用375~750元,中位数375元。随访30天,无患者复发出血,未发现术后严重并发症。结论福爱乐医用胶对肝动脉出血血管栓塞成功率高,安全、有效。     

Intra-arterial injection therapy with ethanol for a patient with renal arteriovenous fistula

A case of renal arteriovenous fistula (A-V fistula) treated by transcatheter embolization using absolute ethanol is reported. The catheter was superselectively placed in the proximal renal artery supplying cirsoid vessels and 15 ml of absolute ethanol was injected into the renal artery at a rate of 1 ml per second. Ten minutes after injection, complete occlusion of the fistula was confirmed. The postembolization syndrome was mild, particularly back pain and fever were mitigated. Repeat arteriogram after 3 months demonstrated persistent occlusion of the fistula. From this experience and a review of the literature, we postulate that the advantages of therapeutic embolization with ethanol for A-V fistula compared with other embolization techniques are the following: (1) persistence of arterial occlusion extending to the peripheral vessels, (2) less frequent possibility of recanalization and collateral formation, (3) less systemic toxicity even if ethanol has escaped into the systemic circulation through A-V fistula, and (4) no danger of accidental embolization of other arteries. Herein, we also review briefly the literature concerning both mechanism and feature of action of ethanol injected into the artery.     

肾动静脉瘘的诊断与治疗

目的 探讨肾动静脉瘘的诊断和治疗方法。方法 回顾性分析8例肾动静脉瘘患者的临床资料。其中原发性动静脉瘘5例，继发于肾肿瘤2例、外伤1例。结果 2例肾肿瘤者1例行肾切除术，1例因肿瘤转移仅行化疗。6例行经皮超选择性肾动脉栓塞治疗。随访6-60个月，1例栓塞失败者行肾切除术，1例瘘管再通者行二次栓塞治疗。一次栓塞成功者4例。结论 影像学检查是诊断肾动静脉瘘的主要手段，除恶性肿瘤外经皮超选择性肾动脉栓塞是治疗肾动静脉瘘的首选方法。     

超选择性肾动脉栓塞治疗医源性肾假性动脉瘤及动静脉瘘的临床研究

目的探讨超选择性肾动脉栓塞治疗医源性肾假性动脉瘤及动静脉瘘的有效性及安全性。方法 29例经保守治疗无效的医源性肾假性动脉瘤及动静脉瘘患者经DSA检查,明确出血部位、特点后行超选择性肾动脉栓塞治疗。监测栓塞后病情变化,评估栓塞效果,评价栓塞前后肾功能变化,记录并发症。结果 29例患者中23例单纯使用弹簧圈栓塞,6例应用弹簧圈+PVA颗粒进行栓塞,首次肾动脉栓塞技术成功率为100%(29/29),临床成功率为96.55%(28/29)。患者栓塞前后肌酐分别为(93.26±28.79)mmol/L和(91.51±27.68)mmol/L,差异无统计学意义(t=1.28,P=0.22)。无肾脓肿、肾功能衰竭等严重并发症出现。结论超选择介入栓塞治疗医源性肾假性动脉瘤及动静脉瘘技术成功率高、临床有效,并且对肾功能无明显影响,是一种安全有效的治疗方法。     

肾动静脉瘘的选择性血管造影与栓塞治疗(附20例报告)

目的 提高肾动静脉瘘介入诊断和治疗水平。方法 20例患者均有反复间歇性全程肉眼血尿，曾行超声、KUB、IVU、CT、泌尿系内镜检查，未能明确病因。行选择性肾动脉造影或(和)超选择性肾段动脉造影确诊为肾动静脉多瘘，采用明胶海绵加鱼肝油酸钠／无水乙醇、聚乙烯醇(PVA)微粒、TH胶、钢圈等对病变血管选择性栓塞。对肾动脉造影的征象和选择性栓塞治疗资料进行分析。结果 20例按影像特点分3类：(1)肾内畸形血管团及动静脉分流现象，共11例；(2)肾动静脉大分支之间高流量的分流而无畸形血管团，共4例；(3)肾动脉主干造影末显示畸形血管团和显著分流，超选择肾段动脉造影或应用气体造影剂则显示微小分流病变，共5例。20例均采用超选择性栓塞供血动脉治疗，栓塞当天肉眼血尿即消失，24～72h后镜下血尿阴转。术后72h内术侧腰部均出现酸痛，尚有发热、腹胀、恶心等症状。结论 选择性肾动脉造影和栓塞术是肾动静脉瘘主要的诊断和治疗方法。CO2造影有助于隐匿型肾动静脉瘘的诊断。     

肝癌合并动静脉瘘71例的诊治体会

目的：探讨合并动静脉瘘（arteriovenous shunt,AVS)的肝癌病人诊治中的特点。方法：我院1996－2001年间收治538例肝癌病人，收集并分析其中AVS71例的临床资料。结果：全组中71例合并AVS，其中肝动脉－门静脉瘘61例，肝动脉－肝静脉瘘8例，混合型2例，在39例中央型肝动脉－门静脉瘘中，30例合并门静脉高压症，行介入治疗84次，完成栓塞化学药物治疗51次（成功率61％）术后肝功能衰竭3例，病人平均生成期5．8个月。结论：肝癌并动静脉瘘发生率高，预后差，加重了病人的门静脉高压症状，并使肝癌的栓塞化疗变得棘手。     

Preoperative percutaneous transhepatic portal embolization with absolute ethanol in patients with hepatocellular carcinoma

Preoperative percutaneous transhepatic portal vein embolization (PTPE) has been used in recent years to decrease the amount of liver resected and to reduce the risk of postoperative liver failure in patients with hepatocellular carcinoma. Various thrombogenic agents have been employed for this purpose. We evaluated the clinical safety and efficacy of absolute ethanol for PTPE and examined the histopathologic changes that follow ethanol embolization of the liver. We studied nine patients with hepatocellular carcinoma who were not originally regarded as surgical candidates because of a high risk of postoperative liver failure. They received preoperative PTPE of the right portal vein, with an average of 22.8 ml of absolute ethanol. The right lobe showed complete obstruction of portal venous branches and massive necrosis of the liver parenchyma. Macroscopically, there was atrophy of the embolized lobes and compensatory hypertrophy of the remaining lobes. The mean volume of the nonembolized lobe increased, from 351 to 585 and 633 ml, 2 and 4 weeks after embolization, respectively. The mean regeneration rate of this lobe was 16.7 cm³/day for the first 2 weeks after embolization and 10.1 cm³/day for the first 4 weeks. Transient dynamic increases in alanine aminotransferase concentrations were seen. All patients subsequently underwent right lobectomy of the liver and survived without severe complications. Portal vein embolization with absolute ethanol makes more extensive hepatectomy possible by reducing the volume necessary to resect, and it preserves the function of the remaining liver.     

A novel treatment of congenital hepatoportal arteriovenous fistula

Congenital hepatoportal arteriovenous fistula is a rare cause of portal hypertension in young children. Unlike the acquired form, which is usually isolated and can be cured by hepatic artery (HA) embolization, recurrence of portal hypertension often occurs with congenital hepatoportal arteriovenous fistula after embolization and/or HA ligation because of early, rapid collateralization and the presence of multiple arterioportal fistula. Although long-term outcome after embolization is not known, liver transplantation has been proposed as the only option for this condition. However, portal vein and hepatic arterial anastomoses are made difficult because of the presence of portal vein arterialization and previous HA ligation, with a significantly increased risk of vascular complications. We report a case where resolution of portal hypertension has been achieved by an end-to-side portocaval shunt, to preserve the portal vein and HA for future liver transplantation, should it be required.     

Renal-sparing procedures in the management of renal arteriovenous fistula]

Five cases of renal arteriovenous fistula which were treated by renal-sparing procedures are reported. Transcatheter arterial embolization was performed in three cases of circoid type arteriovenous fistula. Gross hematuria stopped immediately after the treatment in these three cases. Another two patients, whose arteriovenous fistula were aneurysmal type, were treated by ligation of the feeding artery. Although there were no symptoms after the surgery, the follow-up renal arteriography revealed the residue of a small amount of arteriovenous fistula in one of the aneurysmal type cases. We suggest that the renal arteriovenous fistula be classified into circoid type and aneurysmal type in the diagnosis for the appropriate treatment of renal arteriovenous fistula. It is important to select the renal-sparing procedure according to the type of renal arteriovenous fistula.     

MicroNester coil for neurointervention

A MicroNester coil (MNC) was developed from the Nester coil with a 0.018-in microcatheter. The most specific feature of the MNC is the extended length of 14 cm. Neurointervention involving the MNC was undertaken in 11 patients. Intervention procedures were transvenous embolization for a dural arteriovenous fistula in 4 patients, transarterial embolization for a dural arteriovenous fistula in 2, parent artery occlusion for a cerebral aneurysm in 4, and stent-assisted embolization for a carotid artery dissection in 1. A push technique through microcatheter was used to deploy the MNCs. The MNCs were successfully placed into the venous sinus lesion, feeding artery, parent artery of the aneurysm, and the pseudoaneurysm. There were no major technical complications resulting in morbidity. The postoperative course was uneventful except in 2 cases in which the occluded vessel recanalized. Use of MNCs was safe and feasible for embolization of cerebrovascular lesions. Fewer coils are required in embolization when using MNCs.