肝癌门静脉癌栓伴肝动脉-门静脉分流的栓塞治疗

摘要

Objective To investigate the effect of transcatheter arterial embolization therapy for primary hepatic carcinoma with portal vein tumor thrombus and arterioportal shunts (APS) by using polyvinyl alcohol particles (PVA) and lipiodol emulsion.Methods Selective TACE was performed on 24 patients who had primary hepatic carcinoma complicated with APS.Embolization was performed according to the blood flow features,the shunt vessels and tumor vessels with different injection doses and orders of PVA and lipiodol emulsion.The patients were followed-up to evaluate the indexes such as the outcome of APS,change of tumor size and survival time to investigate the clinical effect.Results APS disappeared in 23 patients after treatment,and tumor sizes reduced after multiple times of treatment in 19 patients,but continued to progress in 5 patients.The recurrence rate of 3-month,6-month and 1-year was 95.83％ (23/24),79.17％ (19/24) and 79.17％(19/24),respectively.Conclusion It is safe and effective to embolize shunt vessels and tumor vessels super-selectively by using PVA together with lipiodol emulsion in primary hepatic carcinoma patients with portal vein tumor thrombus and APS.%目的 探讨聚乙烯醇颗粒(PVA)配合碘油乳剂栓塞治疗门静脉癌栓伴肝动脉-门静脉分流(APS)的可行性及疗效.方法 对24例原发性肝癌伴有门静脉癌栓伴APS患者进行选择性TACE,根据肿瘤血供特点,采用不同的PVA及碘油乳剂注入方式,对分流血管及肿瘤血供进行栓塞.术后观察APS闭塞情况、肿瘤大小变化、生存期等指标.结果 24例中,23例治疗后APS闭塞；多次治疗后19例肿瘤体积缩小,5例病情进展；3、6、12个月及以上生存率分别为95.83％ (23/24)、79.17％ (19/24)、79.17％ (19/24).结论 PVA配合碘油乳剂超选择栓塞原发性肝癌并门静脉癌栓伴APS安全有效.