原发性肝癌伴动静脉瘘介入栓塞治疗62例回顾性分析-论文.pdf

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1、金墼兰塑查!堡旦笙堂笙塑JInterventRadiol2014，Vo1．23，N0．8．——683．——·肿瘤介入Tumorintervention·原发性肝癌伴动静脉瘘介入栓塞治疗62例回顾性分析肖景坤，吕维富，周春泽，张行明，鲁东，侯昌龙，张正峰，王伟昱【摘要】目的回顾性分析原发性肝癌合并动静脉瘘(AVS)的介入栓塞治疗疗效。分析影响其疗效的相关因素。方法回顾性分析62例原发性肝癌合并动静脉瘘的介入栓塞治疗的临床资料，根据血管造影明确AVS的类型、程度后，按不同方式进行堵瘘及肿瘤化疗栓塞治疗。再次造影评价瘘1

2、：1封堵的疗效，单因素和多因素分析影响栓塞疗效的相关因素。结果62例患者中肝动脉一门静脉瘘44例，肝动一静脉瘘11例，肝动脉一门脉瘘合并肝动一静脉瘘4例，肝动脉一肺动脉瘘3例。53例患者12个月后DSA复查发现动静脉瘘消失18例，分流量明显减轻19例，稳定9例，进展7例。单因素分析发现栓塞材料和门静脉癌栓可影响肝动脉一门脉瘘介入栓塞的疗效，而多因素回归分析显示门静脉癌栓是独立危险因素。采用PVA颗粒和碘油无水乙醇混悬液栓塞疗效优于明胶海绵。结论肝癌合并肝动一静脉瘘的介入栓塞治疗应根据动静脉瘘的类型、程度等采用个体化

3、治疗策略，栓塞材料亦在一定程度上影响瘘的再通。【关键词】原发性肝癌；动静脉瘘；栓塞；预后因素中图分类号：R735．7文献标志码：A文章编号：1008．794X(2014)一08．0683—05Interventionaichemoembolizationforprimaryhepatocelluarcarcinomacomplicatedbyarteriovenousshunting：retrospectiveanalysisof62casesX／A0Jing—kun，LVWei，ZHOUChun-ze，ZHANG

4、Xing—ming，LUDong，HOUChang-long，ZHANGZheng一ng，WANGWei-yu．DepartmentoflnterventionalRadiology，AnhuiProvincialHospital，Hefei，AnhuiProvince230002，ChinaCorrespondingauthor：LVWei-fu，E-mail：1wjX39@126．com【Abstract】ObjectiveToretrospectivelyanalyzetheeffectofintervent

5、ionalembolizationforhepatoeelluarcarcinoma(HCC)associatedwitharteriovenousshunting(AVS)，andtodiscussthefactorsinfluencingthetherapeuticresults．MethodsTheclinicaldataof62caseswithHCCassociatedwithAVS，whoweretreatedwithinterventionalchemoembolization，wereretrosp

6、ectivelyanalyzed．BasedonthetypeandextentofAVSidentifiedbyangiographicmanifestations，appropriateobstructionoftheshuntandLipiodolchemoembolizationofHCCwereconducted．ThecurativeefectoftheshuntembolizationwasassessedbyDSAatoneortwomonthsafterthetreatment．Thereleva

7、ntfactorsinfluencingtheprognosisofembolizationwereanalyzedbyusingunivariateandmultivariateCoxregressionanalysismethods．ResultsOfthe62patients，arterioportalshunting(APS)wasdetectedin44，hepaticarterio—venousshunting(HAVS)in11，APStogetherwithHAVSin4，andhepaticart

8、ery-pulmonaryarteryshunting(HAPAS)in3．Re。examinationwithDSAwasearriedoutin53patientsat1—2monthsafterthetreatment。whichshowedthattheshuntingdisappearedin18cases．obviousreductionofth