TACE联合局部热疗治疗肝癌并肝动脉门静脉瘘的短期疗效观察

目的观察肝动脉化学性栓塞（TACE）联合经皮局部热疗治疗肝癌合并肝动脉门静脉瘘（HAPS）的近期治疗效果。资料与方法对25例肝癌合并HAPS患者，先行肝动脉明胶海绵颗粒或弹簧圈堵塞瘘口及供血动脉，必要时加用碘油栓塞，3d后再行经皮穿刺微波凝固治疗（PMCT）或射频消融（PRFA）治疗，术后2个月行CT或MR增强、DSA检查，观察瘘口闭塞、肿瘤坏死及临床症状好转等情况。结果25例27个病灶DSA造影发现43处HAPS，其中中央型21处，周围型22处，经明胶海绵颗粒及弹簧圈栓塞后瘘口及供血动脉完全闭塞。18个病灶进行了PM—CT治疗，9个病灶进行了PRFA治疗。2个月DSA复查，17处HAPS再通（中央型12处，周围型5处）。CT或MR增强扫描示6个病灶完全坏死，19个病灶坏死面积〉50％；8个病灶缩小50％以上，10个病灶缩小25％～50％。所有病例无严重并发症发生，术后腹胀、腹泻及腹水等门脉高压相关症状明显减轻或消失。结论TACE联合经皮局部热疗可以有效地治疗肝癌合并HAPS。

Transcatheter Arterial Embolization Combined with Percutaneous Local Thermal Ablation Therapy to Treat Hepatocellular Carcinoma with Hepatic Arteriovenous Shunts

Objective To evaluate the feasibility and short term clinical effect of transcatheter arterial embolization therapy combined with percutaneous local thermal therapy in treating hepatocellular carcinoma (HCC) with hepatic arteriovenous shunts (HAPS).Materials and Methods 27 tumors with HAPS were treated in 25 HCC patients. The HAPS and the tumor supplying arteries were embolized by Gelfoam granules alone or with coils. The tumors were further treated with percutaneous microwave coagulation therapy (PMCT) or percutaneous radiofrequency ablation therapy (PRFA) 3 days later. DSA and CT or MRI contrast enhancement examination were performed 2 months later to evaluate therapeutic effect.Results 43 HAPS were found in initial hepatic angiography in 25 patients. 21 of them were central-type HAPS, the others were peripheral-type. The HAPS and the tumor supplying arteries were totally embolized by Gelfoam granules alone or with coils. 18 and 9 tumors were treated respectively with PMCT and PRFA. 17 HAPS were recanalized (12 central-type and 5 peripheral-type) by angiography 2 months later. Totally necrosis occurred in 6 tumors and necrosis greater than 50% in area occurred in 19 tumors were depicted by CT or MRI contrast examination, the volume of tumors decreased greater than 50% in 8 tumors and 25%-50% in 10 tumors. The symptoms related with portal hypertension, such as abdominal distension, diarrhea, ascites, were improved or disappeared. No severe complications occurred in all patients.Conclusion Transcatheter arterial embolization combined with percutaneous local thermal therapy could safely and effectively treat hepatocellular carcinoma with hepatic arteriovenous shunts.