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目的探讨并总结肝癌合并动-静脉分流的DSA表现和以分流速度为基础的新分型方法及其在栓塞治疗中的临床意义。方法根据分流速度将中晚期肝癌动-静脉分流分为3型,即:快速型、慢速型和中速型。对32例肝癌合并动-静脉分流患者经DSA检查进行分型,选择相应的栓塞材料进行栓塞封堵治疗。结果 32例中,快速型6例(19%),慢速型16例(50%),中速型10例(31%)。23例(72%)一次封堵成功,4例(13%)二次封堵瘘口消失,3例(9%)因分流口较大,同时伴有门静脉癌栓,未行封堵,2例(6%)因分流口较多且分散仅行部分分流口封堵及栓塞化疗。32例中20例DSA同时显示合并门静脉癌栓(与CT所示相符),超声仅检出16例;栓塞治疗后患者临床症状均有不同程度改善。结论中晚期肝癌患者栓塞术前DSA检查可准确显示动-静脉分流和癌栓情况,以分流速度快慢为依据的分型法简便、实用,在栓塞治疗中有重要的临床意义。
Objective To discuss and summarize the DSA manifestations of hepatocellular carcinoma with arteriovenous shunt and the new classification method based on the shunt velocity and its clinical significance in embolization. Methods Divide the arteriovenous shunt into three types according to the shunting speed, namely: rapid type, slow type and moderate type. Thirty-two cases of HCC with arteriovenous shunt were classified by DSA, and the corresponding embolic material was selected for embolic occlusion. Results Of the 32 cases, 6 were fast (19%), 16 were slow (50%) and 10 were moderate (31%). 23 cases (72%) were successfully blocked at one time, and 4 cases (13%) disappeared at the second time. Three patients (9%) had portal vein tumor thrombus without occlusion due to the larger shunt, 2 Cases (6%) due to more diversion and dispersion of only part of the diversion port closure and embolization chemotherapy. In 32 cases, 20 cases of DSA also showed portal vein tumor thrombus (consistent with CT), and only 16 cases were detected by ultrasound. The clinical symptoms of patients after embolization were improved to some extent. Conclusions DSA before embolization of advanced hepatocellular carcinoma patients can accurately show the status of arteriovenous shunts and tumor thrombus. The typing method based on the speed of diversion is simple and practical and has important clinical significance in embolization.