α-氰基丙烯酸正丁酯栓塞治疗肝细胞癌并肝动脉-门静脉瘘的临床价值

目的 探讨α-氰基丙烯酸正丁酯(N-butyl 2-cyanoacrylate,NBCA)在肝细胞癌(HCC)并肝动脉-门静脉瘘(arterio-portal fistural,APF)栓塞治疗中的临床应用价值.方法 回顾性分析分别使用NBCA(NBCA组,26例)和无水酒精(无水酒精组,54例)栓塞治疗HCC合并APF患者的临床资料.治疗方法为常规经导管动脉化疗栓塞(TACE)过程中先使用液体栓塞剂对APF进行治疗.NBCA组根据APF的动静脉循环时间(≤1、1～2和≥2 s)分别使用不同浓度的NBCA(分别为40%～50%、28%～33%和20%～25%)进行栓塞;无水酒精组则根据APF的分流程度用无水酒精加海绵颗粒等栓塞治疗.两组栓塞中的疼痛反应和肝功能受影响程度的比较采用x2检验,1年生存率的比较采用Log-rank检验,一次性栓塞闭塞成功率的比较采用Fisher's精确检验.结果 栓塞过程中NBCA组有4例、无水酒精组有52例患者感到不同程度疼痛,两组差异有统计学意义(x2=58.86,P＜0.01);一次性栓塞闭塞成功率NBCA组92.3%(24/26)、无水酒精组68.5%(37/54),差异有统计学意义(P＜0.05);两组栓塞前后肝功能的变化(x2=0.652)以及1年生存率差异均无统计学意义(P＞0.05).结论 NBCA柃塞治疗HCC合并的APF安全、有效、准确性高,为HCC合并APF的栓塞治疗提供了一种新的可选择的方法.

The clinical value of treatment for hepatocellular carcinoma complicated with arterio-portal fistula wing N-butyl 2-cyanoacrylate

Objective To evaluate the clinical application of embolization therapy using N-butyl 2-cyanoacrylate(NBCA)for hepatocellular carcinoma(HCC)complicated with arterio-portal fistula(APF).Methods Eighty patients with HCC and APF underwent embolothempy with NBCA(NBCA group,26 patients)or absolute alcohol(alcohol group,54 patients).The APF wag first treated with liquid embolic agent during the TACE procedure.We used NBCA-Lipiodol mixtures in concentration of 20%-50% according to tlle different circulation times of these APF in NBCA group,Absolute alcohol plus gelfoam or other materisis were used for embolization of APF in alcohol group.The pain reaction during the procedure,influence for liver function(X2 test).occlusive suceessfxil rate after single embolization(Fisher's exact test)and the survival rate of 1 year(log-rank analysis)between two groups were compared after the embolotherapy.Results Four patients in NBCA group and 52 patients in alcohol group felt painful during the pmcedures.There wag statistically significant difference between two groups(x2=58.86,P＜0.001).The APF disappeared after only sin~e embolization in 24(92.3%,24/26)cages of NBCA group and in 37(68.5%,37/54)patients of alcohol group.There wag also significant difference between two groups (P=0.024).There were no statistical ditierence in the post.embolization liver function change and 1 year survival rate between two groups.Conclusions The embolization therapy using NBCA for HCC complicated with APF is safe.effective and more accurate.It can be used as a new technique for these patients.