肝癌合并肝动静脉窦的DSA表现及临床意义

目的：探讨中晚期原发性肝癌合并动静脉瘘（AVS）的形成机制、DSA表现及其临床意义。方法：回顾性分析172例中晚期原发性肝癌合并AVS48例（27．9％）。分析其DSA表现，按其类型、位置、及AVS出现时间的早迟分为不同类别。39例经导管化疗栓塞（TAE），9例行单纯灌注（TAI）。结果：48例AVS表现者中，26例获完全缓解（CR）或部分缓解（PR），中位生存时间为8个月。共2月、6月、1年、2年累积生存率分别为70．8％、46．7％、14．0％、10．0％。36例轻中度AVS，24获CR或PR，中位生存时间11月，明显长于重度AVS（4月）（P＜0．01）。TAE有效率64．1％，TAI组为11．1％，两组间有显著差异（P＜0．01）。周围型有效率85．0％明显高于中央型29．2％。TAE有效率64．1％，TAI组为11．1％，两组间有显著差异（P＜0．01）。周围型有效率85．0％，明显高于中央型29．2％。10例出现肝功能衰竭，4例并发消化道出血。结论：DSA能直接而全面显示AVS类型、部位及程度，为治疗及预后提供重要参考价值，对轻中度AVS，TAE安全有效，而对重度AVS，TAE易致严重并发症。

DSA manifestation and clinical significance of arteriovenous shunting in primaryhepatocellular carcinoma of advanced stage

Objective:To explore the DSA manifestation and clinical significance of arteriovenous shunting in hepatocellular carcinoma of advanced stage.Methods:To retrospectively analyze 172 patients with hepatocellular carcinoma,48(27.9%)have AVS.AVS can be particularized different kinds according to their types,the appearance time.39 patients were treated with TAE,9 patients with TAI only.Results:The results showed that 26 patients had CR or PR,with an overall median survival time of 8 months.The cumulative survival rates were 70.8%(2 months),46.7%(6 months),14.0%(1 year),10.0%(2 years).The degree,site and method of therapy are significant predicting factor for complication and efficacy of therapy.Of 36 patients with mild or moderate AVS,24 had CR or PR ,with a median survival time of 11 months,The survival time was significantly longer than that of (4 months)severe AVS (P<0.01).The effective rate of TAE(64.1%)is higher than TAI(11.1%)obviously.Hepatic failure associated with TAE developed in 10 patients,4 patients developed with bleeding varices.Conclusion:DSA can demonstrate the type,the site and the degree of AVS completely and directly.TAE is safe and effective for mild or moderate AVS,but it can cause severe complications in patients presenting with severe AVS,the prognosis had no improvement if treated with TAI alone.