摘要
目的 回顾性研究以无水乙醇为主的不同栓塞模式治疗肝细胞癌 (HCC)合并肝动脉 门静脉瘘 (arterioportalfistulas ,APFs)的综合介入处理方法 ,探讨临床疗效 ,以期提高患者的生存质量和生存期。方法 10 5例HCC患者均有APFs ,临床表现为消化道出血 16例 ,中至大量腹水 3 1例 ,消化道出血并腹水 18例 ,以上 65例中合并腹泻者 2 8例 ,无明显症状者 40例。HCC的介入治疗模式有 :经股动脉化疗栓塞 (TACE) +锁骨下动脉药盒导管系统 (PCS)置入 41例 ,经锁骨下动脉TACE +股动脉PCS置入 3 5例 ,经股动脉TACE 2 6例 ,经股动脉TACE +PCS置入 3例。 10 5例患者共发现APFs 167例次 ,高流量者 75例次 ,低流量者 92例次。APFs的栓塞方式有 :钢圈 +无水乙醇 61例次 ,明胶海绵 +无水乙醇 14例次 ,聚乙烯醇 (PVA)颗粒 +无水乙醇 57例次 ,单纯使用无水乙醇 3 5例次。结果 10 5例患者中 62例 1次性栓塞APFs闭塞 (成功率 59 1% ) ;12例栓塞后重新开通 (开通率 11 4% ) ,经再次栓塞后消失 ;3 1例出现新的APFs(发生率 2 9 5% ,其中 15例共栓塞 2次、13例栓塞 3次、3例栓塞 4次 )。临床上 3 3例消化道出血患者出血停止 ,46例腹水和 2 8例腹泻患者症状消失或缓解。经 3个月至 3年随访 ,3个月、6个月、1年和 2年生存率分别为
Objective To retrospectively study the effect of various interventional embolizing procedures for HCC with arterioportal fistulas (APFs) and to discuss which procedures were more effective Methods One hundred and five cases of HCC with APFs were studied Varices hemorrhage occurred in 16 cases, ascites in 31 cases,hemorrhage with ascites in 18 cases,28 cases with diarrhea in above 65 cases,and the other 40 cases without significant symptoms The treatments for HCC consisted of TACE through femoral artery + port catheter system (PCS) through subclavian artery in 41 cases,TACE + PCS both through subclavian artery in 35 cases,TACE through femoral artery in 26 cases,and TACE + PCS both through femoral artery in 3 cases A total of 167 APFs was revealed in all 105 cases,with high flow in 75 APFs and low flow in 92 APFs There were 4 methods fo r embolizing APFs,including steel coils and ethanol in 61 APFs, gelfoam and ethanol in 14 APFs,PVA and ethanol in 57 APFs,and ethanol only in 35 APFs Results The APFs disappeared after only single embolization in 62 cases,and the successful rate was 59 1% APFs reopened in 12 cases,and the reopened rate was 11 4%,which disappeared after the second embolization New APFs were found in 31 cases,and the appearance rate was 29 5%; in whom twice procedures had been performed in 15 cases,3 times in 13 cases,and 4 times in 3 cases Varices hemorrhage stopped in 33 of 34 cases,ascites (46 out of 49 cases) and diarrhea (28 out of 28 cases) disappeared or alleviated After a 3-month to 3-year’s follow-up,the survival rate at 3 months,6 months,1 year,and 2 years was 96 2%,82 9%,65 6%,and 21 9%,respectively Conclusion Embolization of APFs with coil and ethanol was as safe and effective as with PVA and ethanol,and both methods could improve the quality of life of the patients TACE combined with integrative treatment for HCC could improve the survival rate
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2004年第1期36-39,共4页
Chinese Journal of Radiology
关键词
原发性肝癌
肝动脉-门静脉瘘
介入治疗
疗效观察
Carcinoma,hepatocellular
Arteriovenous fistula
Embolization,therapeutic
Ethanol
