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[目的]探讨原发性肝癌合并肝动—静脉瘘的介入栓塞治疗方法及疗效。[方法]回顾性分析32例经DSA检查确诊为原发性肝癌伴有肝动—静脉瘘患者的临床资料。根据瘘口部位、大小及肿瘤染色情况,采用明胶海绵和(或)无水酒精和(或)聚乙烯醇(PVA)封堵瘘口并行碘油化疗栓塞,观察其疗效。[结果]28例完成碘油化疗栓塞(TACE),其中23例一次封堵成功,5例因有多发瘘口,反复栓塞,仍有少量瘘口不能完全封堵。4例因瘘口大,同时有门静脉主干瘘,仅行化疗灌注(TAI)。在后续介入治疗中发现,瘘口封堵成功者,9例瘘口重新开通或有新的瘘口出现,3例再次封堵瘘口后成功。术后3个月、6个月、12个月生存率分别为93.75%、78.13%、37.50%。[结论]对于原发性肝癌合并肝动—静脉瘘,术中有效的封堵瘘口能为肿瘤的碘化油栓塞提供良好的治疗环境,可提高介入治疗的疗效,延长患者的生存时间。
[Objective] To investigate the interventional treatment and efficacy of interventional embolization of primary hepatic carcinoma with hepatic arteriovenous fistula. [Methods] The clinical data of 32 patients diagnosed as primary liver cancer with hepatic arteriovenous fistula by DSA were retrospectively analyzed. According to the location, size and tumor staining of fistula, gelatin sponge and / or anhydrous alcohol and / or polyvinyl alcohol (PVA) were used to occlude the fistula and treated with lipiodol chemoembolization to observe the curative effect. [Results] 28 cases completed TACE, of which 23 cases were successfully blocked at one time, 5 cases had multiple fistulas, repeated embolization, and still a small number of fistulas could not be completely blocked. 4 cases of fistula, portal vein fistula, only chemotherapy infusion (TAI). Follow-up intervention in the discovery of successful fistula occlusion, 9 cases of reopening of fistula or a new fistula appears, 3 cases of occlusion of the fistula again after the success. The survival rates at 3 months, 6 months and 12 months after operation were 93.75%, 78.13% and 37.50% respectively. [Conclusion] For primary hepatocellular carcinoma combined with hepatic arteriovenous fistula, an effective intraoperative occlusion fistula can provide a good therapeutic environment for iodized oil embolization of the tumor, which can improve the therapeutic effect of interventional therapy and prolong the survival time of patients.