摘要
目的 研究肝癌中肝动 -静脉瘘的发病率、分型、发生部位以及与肝癌类型、肿瘤血供和门脉高压之间的关系 .方法 110例选自我科 1989/1999间收治的经临床和影像资料证实的 5 83例肝癌患者 .均采用 Seldinger技术行 DSA检查证实为肝动 -静脉瘘 .其中男 10 2例 ,女 8例 ,年龄 2 7～ 70岁 ,平均 48.5岁 .原发性肝癌 10 3例 ,转移性肝癌 7例 (其中原发结肠癌 3例 ,壶腹癌 2例 ,胰腺癌 1例 ,贲门癌 1例 )合并腹水 5 8例 ,上消化道出血 31例 .行纤维胃镜检查 33例 ,上消化道钡餐检查 30例 .结果 1肝癌中肝动 -静脉瘘平均发生率为 18.9% . 2肝动 -静脉瘘多发生于多血供、巨块型、原发性肝癌 (发生率分别为 80 .9% ,6 2 .7%和 93.6 % ) . 3肝动 -静脉瘘中 10 3例为单纯型 ,占 93.6 % ,表现为 :肝动脉 -门静脉瘘97例 (88.2 % ) ,肝动脉 -肝静脉瘘 4例 ,肝动脉 -下腔静脉瘘 2例 . 7例复杂型表现为 :同时存在肝动脉 -门静脉瘘、肝动脉 -下腔静脉瘘 3例 ,肝动脉 -下腔静脉瘘、肝动脉 -肝静脉瘘 1例和先肝动脉 -门静脉瘘 ,后肝动脉 -下腔静脉瘘 1例 ,先肝动脉 -下腔静脉瘘、后肝动脉 -门静脉瘘 1例和 3处肝动脉 -门静脉瘘1例 . 4按肝动 -静脉瘘发生部位分型 :周围型 95例(86 .4% ) ,中央型 15例 (13.6 % ) .
AIM To investigate incidence rate of hepatic arteriovenous fistula (HA V) among patients with hepatic cancer, its typing and the relationship with types of hepatic cancer and portal hypertension. METHODS 110 cases were selected from the 583 cases of hepatic cancer verified clinically by radiological images and admitted by our department from 1989-1999. The 110 cases were verified as hepatic arteriovenous fistula by Seldinger technique with DSA, among which 102 were males and 8 females aged between 27 and 70 (average=48.5). 103 cases were primary and 7 were metastatic. The latter included 3 cases of primary carcinoma of colon, 2 carcinoma of ampulla, 1 carcinoma of pancreas and 1 cardiac cancer. Besides, there were 58 cases of concurrent ascites and 31 cases of hemorrhage of upper digestive tract. 33 were given gastrofiberscopy and 30 were given barium meal check of upper digestive tract. RESULTS ① Average incidence rate of hepatic arteriovenous fistula among patients with hepatic cancer was found to be 18.9%. ② Hepatic arteriovenous fistula usually occurred in patients with sufficient blood supply, massive and primary types of hepatic cancer. Their incidence rates were 80.9% and 62.7% and 93.6% respectively. ③ Among the 110 hepatic arteriovenous fistula cases, 103 were of the simple type, accounting for 93.6%, and could be divided into 97 cases of hepatic arterio pylic fistula (HA PV) (88.2%), 4 hepatic arteriovenous fistula and 2 fistula of hepatic artery and inferior vena cava (HA IVC). 7 cases were of the complicated type and could be divided into 3 cases of hepatic arterio pylic fistula coexisting with fistula of hepatic artery and inferior vena cava, 1 fistula of hepatic artery and inferior vena cava coexisting with hepatic arteriovenous fistula, 1 hepatic arterio pylic fistula followed by fistula of hepatic artery and inferior vena cava, 1 fistula of hepatic artery and inferior vena cava followed by hepatic arterio pylic fistula and 1 fistula of hepatic pylic at 3 different locations one after another. ④ According to the locations of the fistula, the 110 cases can be divided into two main types: 95 peripheral ( 86.4% ) and 15 central (13.6%). ⑤ Barium meal examination and gastrofiberscopy of upper digestive tract of concurrent portal hypertension cases indicate that the positive rate of varices of esophagus detected by gastrofiberscopy was much higher than that by barium meal examination. CONCLUSION ① Hepatic arteriovenous fistula is highly incidental to hepatic cancer. The incidence rate among primary cases is significantly higher than that among metastatic ones. ② Hepatic arteriovenous fistula is usually found among cases of sufficient blood supply and massive types, which usually indicates the severity of lesion. ③ Hepatic arterio pylic fistula is probably an important cause of portal hypertension in the intermediate and advanced phases of hepatic cancer. ④ Portal hypertension caused by hepatic arteriovenous fistula is clinically characterized by ascites and hemorrhage. ⑤ The positive rate of varices of esophagus detected by gastrofiberscopy is significantly higher than that by barium meal examination. Digital substraction angiography (DSA) should therefore be included in the routine examination of hepatic cancer patients with concurrent portal hypertension. ⑥ Embolism of hepatic artery can block hepatic arteriovenous fistula, relieve ascites and hemorrhage of upper digestive tract caused by portal hypertension and abate the remote metastasis caused by venous shunt.
出处
《第四军医大学学报》
2000年第11期1410-1414,共5页
Journal of the Fourth Military Medical University
关键词
肝癌
肝动静脉瘘
门脉高压
血管造影数字减影
liver neoplasms
hepatic arteriovenous fistula
hypertension, portal
digital substraction angiography
