肝癌合并不同类型动静脉瘘的介入治疗方法探索

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1、肝癌合并不同类型动静脉瘘的介入治疗方法探索雷明志1陈燕浩2张树桐2(1湖北省黄M市罗田县人民医院湖北黄M438600)(2武汉市中心医院湖北武汉430014)【摘要】目的探讨肝癌合并动静脉瘘的介入治疗方法。方法回顾性分析34例肝癌患者行DSA造影，判断有无动静脉瘘，再根据实际情况选择实行肝动脉内化疗栓塞治疗或肝动脉内化疗术，比较两者之间的疗效。结果DSA诊断肝癌合并动静脉瘘者11例，中央型动门静脉瘘6例，周围型动门静脉瘘4例，混合型1例，9例行肝动脉内化疗栓塞术，2例行肝动脉内化疗术。术后，所有患者肝功能均有不同程度好转，行肝动脉内化疗栓塞术中位生存时间，2月、6月、1年总体累积生存率

2、均高于肝动脉内化疗术患者。结节型及巨块型肝癌中位生存时间，2月、6月、1年总体累积生存率相当，且均明显高于弥漫型肝癌。结论周围型、动静脉瘘的患者封堵瘘U较容易，而中央型动静脉瘘患者封堵瘘U难度较大，应尽量使用栓塞剂有效封堵瘘口血流或使用微导管绕过瘘口后再行TACE,如无法有效处理瘘口，则仅行TAI。【关键词】肝癌动静脉瘘肝动脉内化疗栓塞术肝动脉内化疗术【中图分类号】R730.5【文献标识码】A【文章编号】1672-5085(2014)20-0071-02InterventionalTherapyofhepaticcarcinomacomplicatedbyHepaticarterial

3、-portalvenousshuntsofvarioustype.【Abstract】ObjectiveToexploretheinterventionaltherapeuticmethodsforhepatocellularcarcinomaaccompaniedwitharteriovenousshunt.Methods34caseswithprovedhepatocellularcarcinoma(HCC)wereunderwentDSAfirstly,judgewhethertoexistHepaticarterial-portalvenousshunts,thentransc

4、atheterarterialchemoembolization(TACE)ortranscatheterarterialinfusion(TAI)wereperformedinallcases•wecomparedwiththetherapeuticeffectofTACEwiththeoneofTAI.ResultsTotally11caseswerepresentedwitharteriovenousshunt,including6caseswithhepaticartery-portalveinshuntsofcentraltype,4caseswiththeonesofper

5、ipheraltype,1cseswiththeonesofmixedtype.Hepaticfunctionwasimprovedafterinterventionaltherapy.Themediansurvivaltime,twomonthssurvivalrate,sixmonthssurvivalrateandoneyearsurvivalrateofthecasereceivedTACEwerehigherthanthecasesreceivedTAI.Theonesofhugehepaticcarcinomaandnoduloushepaticcarcinomawereh

6、igherthantheonesofasystematichepaticcarcinoma.Theonesofhugehepaticcarcinomaweresimilarwiththeonesofnoduloushepaticcarcinoma.ConclusionTheblockingsofhepaticartery-portalveinshuntsofperipheraltype,areeasierthantheonesofcentraltype.Whenwesucceedtoblockingthehepaticartery-portalveinshuntsandusemicro

7、cathetertobypassthehepaticartery-portalveinshunts,TACEisusedbutthehepaticartery-portalveinshuntshastobetreatedwithTAIonly.【Keywords】hepatocellularcarcinomaHepaticarterial-portalvenousshuntstranscatheterarterialchemoembolizat