TACE联合栓塞治疗中晚期肝癌合并肝动脉-门静脉瘘

目的 探讨TACE联合瘘口栓塞对中晚期原发性肝癌（PHC）合并肝动脉-门静脉瘘（HAPF）的干预效果。方法 回顾性分析65例伴HAPF的中晚期PHC患者，根据肝动脉造影中门静脉显影时间将HAPF分为低流量型（<1 s，31例）、中流量型（1~3 s，25例）及高流量型（>3 s，9例），均给予TACE联合瘘口栓塞治疗。统计术后1个月瘘口封堵情况和临床疗效，及术后3、6、12、24个月患者生存率。结果 48例（73.85%，48/65）HAPF患者经一次性完全封堵，包括26例（26/31，83.87%）低流量型、18例（18/25，72.00%）中流量型及4例（4/9，44.44%）高流量型（P=0.046）。治疗后肿瘤进展11例，稳定19例，缓解35例，其中低流量型HAPF患者肿瘤进展2例、稳定3例、缓解26例，中流量型、高流量型HAPF患者分别为2、14、9例及7、2、0例（P=0.001）。术后3个月患者生存率为87.69%（57/65），6个月67.69%（44/65），12个月43.08%（28/65），24个月6.15%（4/65）；低、中、高流量型患者生存率差异有统计学意义（P<0.001）。结论 TACE联合瘘口栓塞可有效治疗PHC合并HAPF，且对低流量型HAPF治疗效果更佳。

TACE combined with embolization of artery-portal venous fistula in treatment of advanced hepatocellular carcinoma

Objective To explore the value of TACE combined with interventional embolization of hepatic arterio-portal fistula (HAPF) in treatment of primary hepatocellular carcinoma (PHC). Methods Clinical data of 65 advanced PHC patients with HAPF were retrospectively analyzed. According to the time of portal vein appearance during hepatic artery angiography, there were 31 patients with low flow type HAPF (<1 s), 25 with medium flow type (1-3 s) and 9 with high flow type HAPF (>3 s). The patients were treated with TACE combined with embolization of the fistula. Then clinical efficacy and closure of fistula were evaluated 1 month after treatment, and the postoperative survival rates of 3, 6, 12 and 24 months were counted. Results HAPF were successfully one-time embolized in 48 cases (73.85%, 48/65), including 26 cases (26/31, 83.87%) of low-flow type, 18 cases (18/25, 72.00%) with medium-flow type and 4 cases (4/9, 44.44%) with high-flow type HAPF (P=0.046). One month after treatment, tumor progression was observed in 11 patients, while stable in 19 and remission in 35 patients, respectively. Tumor progression, stable and remission was found in 2, 3 and 26 cases among patients with low-flow orifice fistula, 2, 14 and 9 cases among those with medium-flow type HAPF, 7, 2 and 0 case among high-flow type HAPF, respectively (P=0.001). The survival rate was 87.69% (57/65) 3 months, 67.69% (44/65) 6 months, 43.08% (28/65) 12 months and 6.15% (4/65) 24 months after treatment. The difference of survival rate among patients with low-, medium-and high-flow type HAPF was statistically significant (P<0.001). Conclusion TACE combined with interventional embolization of HAPF has good therapeutic effect, especially for PHC patients with low-flow type HAPF.