肝癌合并动静脉瘘的介入诊断及治疗

目的 分析肝细胞癌(HCC)合并肝动脉一静脉瘘(HAVS)的诊断及介入处理方法，探讨临床疗效。方法 收治的453例肝细胞癌，33例合并HAVS。根据造影诊断分别进行明胶海绵或弹簧圈堵塞瘘口，合并或单独使用丝裂霉素、卡铂粉、碘油混合乳剂进行瘤体栓塞。此外，对于冈HAVS所致的严重门脉高压反复上消化道出血3例患者，实施了经皮肝穿刺胃冠状静脉栓塞术。结果 肝动脉-门静脉瘘(HAPS)24例，HAVS7例，混合型2例：HAVS经处理瘘口达到完全栓塞后行肝动脉化疗栓塞(TACE)时，26例丝裂霉素、卡铂、碘油乳剂均能较好地沉积在瘤体内其余7例瘤体内栓塞剂沉积不好其中3例反复上消化道出血的患者经皮肝穿刺胃冠状静脉栓塞术后1d出血停止。结论 对于肝细胞癌合并HAVS患者，数字减影血管造影(DSA)是必要的检查手段，栓塞治疗是有效的治疗方法。

Interventional diagnosis and treatment for hepatocellular carcinoma with arteriovenous shunting

Objective To explore interventional diagnosis and treatment of hepatocellular carcinoma(HCC) with arteriovenous shunting(AVS) and evaluate the clinical effect of interventional treatment.Methods There were 33 patients with AVS in 453 HCCs. According to the angiography diagonosis ,the patients with AVS underwent embolizing the shunting with gelfoam or coil and with iodinate oil with chemotherapy medicine.There were 3 patients with recurrent upper digestive tract hemorrhage underwent the embolization of the stomach coronary vein. Results There are 24 cases with hepatic arterioportal shunt (HAPS), 7 with hepatic arteriovenous shunt (HAVS) and 2 with mixed type. Iodinate oil deposit very good in the foci of the tumor in 26 patients with AVS after embolization treatment . There are 7 cases presented with poor iodinate oil deposit.The bleeding ceased within 1 day after interventional therapy for 3 patients with recurrent upper digestive tract hemorrhage .Conclusions DSA is the indispensable examination before interventional therapy for the patients with HCC. Embolized therapy is a effective treatment approach for the patients with HCC associated with AVS.