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目的探讨原发性肝癌(PLC)合并不同类型肝动脉-门静脉瘘(APS)的介入栓塞近期疗效。方法接受两次以上序贯栓塞治疗的45例PLC合并APS患者,根据血管造影表现将APS分为中央型和周围型,采用超选择插管堵瘘及化疗栓塞肿瘤。观察患者主要症状改善情况,对比两种类型实时瘘口变化、肿瘤碘油沉积及再次治疗时瘘口表现。统计学分析应用SPSS 18.0软件包,计量资料采用两样本均数t检验,计数资料采用χ2检验,以P<0.05为差异有统计学意义。结果 APS中央型20例,周围型25例。实时瘘口改善率84.4%,再次治疗瘘口再通及进展率26.7%,中央型和周围型瘘口变化比较差异无统计学意义(χ2=0.617,P=0.739;χ2=1.278,P=0.262),周围型肿瘤碘油沉积优于中央型(χ2=7.605,P=0.006)。术后1周内转氨酶升高,2～3周恢复至术前水平。大部分患者门静脉高压症状改善。结论超选择介入栓塞治疗PLC合并APS短期内可以控制肿瘤,改善异常分流并部分缓解门静脉高压症状,但瘘口易复发进展,中央型瘘肿瘤区碘油不易沉积。
Objective To investigate the short-term curative effect of interventional embolization of primary hepatocellular carcinoma (PLC) with different types of hepatic artery-portal venous fistula (APS). Methods Forty-five PLC patients with APS who underwent sequential embolization were divided into central and peripheral APS according to angiographic findings. Superselective catheterization and chemoembolization of tumor were performed. To observe the improvement of the main symptoms of patients, compare two types of real-time fistula changes, tumor lipiodol deposition and re-treatment of fistula performance. Statistical analysis using SPSS 18.0 software package, measurement data using two-sample mean t test, count data using χ2 test, P <0.05 was considered statistically significant. Results APS central type in 20 cases, 25 cases of peripheral type. The rate of real-time fistula improvement was 84.4%, and the rate of recanalization and progression was 26.7% again. There was no significant difference in the changes of central and peripheral fistulas (χ2 = 0.617, P = 0.739; χ2 = 1.278, P = 0.262 ), Peripheral tumor lipiodol deposition is superior to the central type (χ2 = 7.605, P = 0.006). Transaminases increased within 1 week after surgery and returned to preoperative levels in 2 to 3 weeks. Most patients with portal hypertension symptoms improved. Conclusion Superselective interventional embolization in PLC combined with APS can control tumor in short term, improve abnormal diversion and relieve the symptoms of portal hypertension. However, the recurrence of fistula is easy and the lipiodol in central fistula is not easy to deposit.