王诗学

[摘要] 目的 探讨原发性肝癌（PHC）合并肝动脉-门静脉瘘（HA-PVS）的DSA表现及介入治疗的临床效果。方法 以2014年1月—2017年6月该院68例PHC合并HA-PVS患者为例，全部患者均行DSA检查及介入治疗，观察影像学表现及临床疗效。结果 患者一次手术成功率98.53%，肿瘤客观缓解率54.41%，疾病控制率94.12%。结论 DSA能够为PHC合并HA-PVS的临床诊治提供有价值的影像学参考，针对性予以PHC合并HA-PVS介入治疗效果显著，值得推广使用。

[关键词] 肝癌；肝动脉-门静脉瘘；DSA；介入治疗

[中图分类号] R735 [文献标识码] A [文章编号] 1674-0742（2018）02（a）-0188-03

DSA Manifestations and Interventional Treatment of Hepatocellular Carcinoma Complicated with Hepatic Portal Venous Fistula

WANG Shi-xue

Interventional Radiology Department， Xinyi Peoples Hospital， Xinyi， Jiangsu Province， 221400 China

[Abstract] Objective This paper tries to investigate the DSA features of primary hepatic carcinoma （PHC） complicated with hepatic arterial portal venous fistula（HA-PVS） and the clinical effect of interventional therapy. Methods 68 cases of PHC with HA-PVS patients from January 2014 to June 2017 in this hospital were taken as the example， all patients underwent DSA examination and interventional treatment， the imaging performance and clinical efficacy were observed. Results The success rate was 98.53%， the tumor objective remission rate was 54.41%， and the disease control rate was 94.12%. Conclusion DSA can provide valuable imaging reference for clinical diagnosis and treatment of PHC combined with HA-PVS. Targeted interventional therapy with PHC combined with HA-PVS has significant effect and is worthy of popularization and application.

[Key words] Liver cancer； Hepatic artery portal vein fistula； DSA； Interventional therapy

肝癌介入治疗是将栓塞剂或抗癌药物经股动脉注入肝动脉的局部化疗技术，其疗效已得到临床广泛肯定，目前已经成为非开腹手术治疗肝癌的首选方法[1]。HA-PVS是肝癌常见并发症，可使肿瘤和门静脉的血液相通，易造成肿瘤肝内散播和肝外转移，影响肝癌介入治疗效果[2]。对此，肝癌介入治疗中明确诊断HA-PVS并有效处理对提高疗效、改善预后至关重要。文章现以2014年1月—2017年6月该院68例患者为例，分析PHC合并HA-PVS的DSA表现及介入治疗效果，现报道如下。

1 资料与方法

1.1 一般资料

以該院收治的68例PHC合并HA-PVS患者为研究对象。纳入标准：①诊断符合《原发性肝癌诊疗规范》（2017版）相关标准[3]；②介入治疗指征；③签署知情同意书。排除标准[4]：①PHC广泛转移，患者合并衰竭迹象；②DSA禁忌证；③Child-Pugh C级肝功能障碍；④介入治疗前PHC治疗史；⑤合并感染；⑥门静脉高压致逆向血流。入选病例中，男56例，女12例，年龄30～80岁，平均（59.6±8.4）岁。PHC组织学分型：肝细胞癌63例，胆管细胞癌5例。病理大体分型：弥漫型29例；结节型22例；……