微创医学

【摘要】目的探讨数字减影血管造影（DSA）技术在肝癌合并肝动脉-门静脉瘘介入治疗中的应用价值。方法选取行DSA检查的50例肝癌合并肝动脉-门静脉瘘患者为研究对象，观察其肝癌合并肝动脉-门静脉瘘分型与肝癌病理类型关系、DSA特征、治疗前后实验室相关指标［丙氨酸转氨酶（ALT）、甲胎蛋白（AFP）］的变化以及临床治疗效果。结果原发性肝癌患者病理类型以巨块型居多（20例），其次为结节型（19例），最少为弥漫型（11例）；DSA影像学表现主要有造影肝动脉期单条或多条门脉主干，或其分支显影，而显影发生部位又可分为中央型（26例）、周围型（17例）及混合型（7例）；在DSA辅助检查下介入治疗1个月后患者ALT、AFP表达水平均较治疗前显著降低（P＜0.05）；肿瘤成功栓塞45例（90.00%），其中中央型成功栓塞率81.48%（21/26），与周围型成功栓塞94.12%（16/17）比较，差异无统计学意义（P＞0.05）；成功跨过瘘口栓塞肿瘤22例（44.00%），其中中央型成功栓塞率76.92%（20/26），显著高于周围型成功栓塞率35.29%（6/17）（P＜0.05）；未跨过瘘口栓塞肿瘤23例（46.00%），其中周围型成功率58.82%（10/17），显著高于中央型成功率11.54%（3/26）（P＜0.05）；瘘口成功封堵32例（64.00%），中央型成功率50.00%（13/26），与周围型成功率75.00%（12/16）比较，差异无统计学意义（P=0.116）；介入治疗后12个月随访，瘘口恢复较好。结论DSA技术是肝癌合并肝动脉-门静脉瘘直观可靠的诊断方法，为介入治疗提供重要参考依据。

【Abstract】 ObjectiveTo explore the application value of digital subtraction angiography (DSA) in the interventional therapy for hepatic cancer complicated with hepatic arteryportal vein fistula. MethodsFifty patients with hepatic cancer complicated with hepatic arteryportal vein fistula were enrolled, and underwent DSA. The relation between the classification of hepatic arteryportal vein fistula and pathological type of hepatic cancer, the features of DSA, the changes in laboratory indices including the alanine transaminase (ALT) and alpha fetoprotein (AFP) and clinical efficacy were observed. ResultsIn the primary hepatic cancer patients, the massive type (n=20) and nodular type(n=19) were the most and the secondary common pathological type respectively. And the cases of diffuse type was least(n=11). Single or multiple main trunks of portal vein or the branches were developed on the hepatic artery phase images of DSA. The sites developed on the images consisted of central type (n=26), peripheral type (n=17) and mixed type (n=7). The ALT and AFP levels significantly decreased after one month of DSAassisted interventional therapy compared to the levels before treatment(P＜0.05). Embolization was successfully completed in 45 cases(90.00%). There was no significant difference in the successful embolization rate between the central type and peripheral type［81.48%（21/26）vs. 94.12% (16/17),P＞0.05］.Embolization over the fistula was successfully completed in 22 cases (44.00%).The successful embolization rate of the central type was significantly higher than the rate of the peripheral type［76.92%（20/26）vs 35.29%（6/17）,P＜0.05］. Embolization before the fistula was successfully completed in 23 cases (46.00%).The successful embolization rate of the peripheral type was significantly higher than the rate of the central type［58.82%（10/17）vs 11.54%（3/26）（6/17）,P＜0.05］. Fistula closure was successfully completed in 32 cases (64.00%). There was no significant difference in the successful rate between the central type and peripheral type［50.00%（13/26）vs 75.00%（12/16）,P=0.116］.The patients were followed up after 12 months of interventional therapy, and achieved good closure of fistula. ConclusionDSA is an intuitive and reliable diagnostic method for hepatic cancer complicated with hepatic arteryportal vein fistula, and can provide an important reference for interventional therapy.