肝癌合并不同类型动静脉瘘的介入治疗方法探索.docVIP

精品论文 参考文献 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湖北省黄冈市罗田县人民医院 湖北黄冈 438600) 　　(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口较容易，而中央型动静脉瘘患者封堵瘘口难度较大，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）20-0071-02 　　Interventional Therapy of hepatic carcinoma complicated by Hepatic arterial-portal venous shunts of various type. 　　【Abstract】Objective To explore the interventional therapeutic methods for hepatocellular carcinoma accompanied with arteriovenous shunt. Methods 34 cases with proved hepatocellular carcinoma(HCC) were underwent DSA firstly, judge whether to exist Hepatic arterial-portal venous shunts. then transcatheter arterial chemoembolization (TACE) or transcatheter arterial infusion (TAI) were performed in all cases . we compared with the therapeutic effect of TACE with the one of TAI. Results Totally 11 cases were presented with arteriovenous shunt, including 6 cases with hepatic artery-portal vein shunts of central type, 4 cases with the ones of peripheral type, 1 cses with the ones of mixed type. Hepatic function was improved after interventional therapy. The median survival time,two months survival rate, six months survival rate and one year survival rate of the case received TACE were higher than the cases received TAI. The ones of huge hepatic carcinoma and nodulous hepatic carcinoma were higher than the ones of asystematic hepatic carcinoma. The ones of huge hepatic carcinoma were similar with the ones of nodulous hepatic carcinoma. Conclusion The blockings of hepatic artery-portal vein shunts of peripheral type, are easier tha