原发性肝癌并不同类型动-静脉瘘的介入放射治疗

目的研究原发性肝癌合并动静脉瘘的DSA表现的分型及相应的介入治疗措施.方法原发性肝癌合并动静脉瘘92例,依据DSA表现分为二型,各有轻、中、重三度.对轻度瘘者直接采用碘化油肝动脉栓塞化疗;对中度瘘者首次介入治疗采用明胶海绵颗粒栓塞化疗,约1月后复查,如果瘘消失,则采用碘化油栓塞化疗;对重度瘘者,仅采用肝动脉灌注化疗.结果轻度瘘47例,共行152次碘化油肝动脉栓塞化疗,1年和2年生存率分别是68.1%和27.7%;中度瘘29例,首次介入治疗均行明胶海绵颗粒栓塞化疗,1月后27例得到复查,其中18例A-V瘘消失,获得碘化油肝动脉栓塞化疗共42次,1年和2年生存率分别为37.9%和6.9%;重度瘘16例,仅各行1次肝动脉灌注化疗,半年后随访无1例生存.结论1.将肝癌并A-V瘘在程度上进行分级有助于选择恰当的介入治疗方法;2.对轻、中度瘘的栓塞化疗是提高此类患者疗效的关键,尤其是对轻度瘘者的处理.

Angiographic classification correlated to transcatheter arterial embolization (TAE) for primary hepatic carcinoma with A- V shunt

Objective To evaluate transcatheter arterial embolization (TAE) for various types of A-V shunt in primary heaptic carcinoma. Methods A-V shunt was found in 92 of 656 patients with primary heaptic cancer who underwent TAE therapy from 1989 to 2000. A-V shunts were classified into two types based on DSA: arterio portal vein shunt and hepatic arterio vein shunt. Each type of A-V shunts was further classified into three degrees: light, moderate and severe.Results One hundred and fifty four sets of transcatheter arterial chemoembolization (TACE) with iodized oil were performed in 47 patients with light A-V shunt. No extra interventional technique was taken in patients with such type of A-V shunt. However, TAE with gelforam particles was used before TACE in 28 patients with the type of moderate A-V shunt. Consequently, TACE was finally done in 18 patients of this series after disapearence of A-V shunt post 1-2 sets of TAE. Only transcatheter arterial chemo infusion without embolization was taken in 16 patients with severe A-V shunt. The 1 and 2 year survival rates were 68.1% vs 32.1% and 37.9% vs 6.9% in the series with the type of light vs the type of moderate A-V shunt. All patients died within 6 months in the type of severe A-V shunt.Conclusion The classification of A-V shunts in the patients with primary hepatic cancer is useful for selection of different interventional technique. TACE is a safe and effective procedure for those with light or moderate A-V shunt, especially for the patients with the type of light A-V shunt.