CAJ | 학술논문

目的：回顾性分析原发性肝癌合并动静脉瘘（AVS）的介入栓塞治疗疗效。分析影响其疗效的相关因素。方法回顾性分析62例原发性肝癌合并动静脉瘘的介入栓塞治疗的临床资料，根据血管造影明确AVS的类型、程度后，按不同方式进行堵瘘及肿瘤化疗栓塞治疗。再次造影评价瘘口封堵的疗效，单因素和多因素分析影响栓塞疗效的相关因素。结果62例患者中肝动脉-门静脉瘘44例，肝动-静脉瘘11例，肝动脉-门脉瘘合并肝动-静脉瘘4例，肝动脉-肺动脉瘘3例。53例患者1~2个月后DSA复查发现动静脉瘘消失18例，分流量明显减轻19例，稳定9例，进展7例。单因素分析发现栓塞材料和门静脉癌栓可影响肝动脉-门脉瘘介入栓塞的疗效，而多因素回归分析显示门静脉癌栓是独立危险因素。采用PVA颗粒和碘油无水乙醇混悬液栓塞疗效优于明胶海绵。结论肝癌合并肝动-静脉瘘的介入栓塞治疗应根据动静脉瘘的类型、程度等采用个体化治疗策略，栓塞材料亦在一定程度上影响瘘的再通。
목적：회고성분석원발성간암합병동정맥루（AVS）적개입전새치료료효。분석영향기료효적상관인소。방법회고성분석62례원발성간암합병동정맥루적개입전새치료적림상자료，근거혈관조영명학AVS적류형、정도후，안불동방식진행도루급종류화료전새치료。재차조영평개루구봉도적료효，단인소화다인소분석영향전새료효적상관인소。결과62례환자중간동맥-문정맥루44례，간동-정맥루11례，간동맥-문맥루합병간동-정맥루4례，간동맥-폐동맥루3례。53례환자1~2개월후DSA복사발현동정맥루소실18례，분류량명현감경19례，은정9례，진전7례。단인소분석발현전새재료화문정맥암전가영향간동맥-문맥루개입전새적료효，이다인소회귀분석현시문정맥암전시독립위험인소。채용PVA과립화전유무수을순혼현액전새료효우우명효해면。결론간암합병간동-정맥루적개입전새치료응근거동정맥루적류형、정도등채용개체화치료책략，전새재료역재일정정도상영향루적재통。
Objective To retrospectively analyze the effect of interventional embolization for hepatocelluar carcinoma (HCC) associated with arteriovenous shunting (AVS), and to discuss the factors influencing the therapeutic results. Methods The clinical data of 62 cases with HCC associated with AVS , who were treated with interventional chemoembolization , were retrospectively analyzed. Based on the type and extent of AVS identified by angiographic manifestations, appropriate obstruction of the shunt and Lipiodol chemoembolization of HCC were conducted. The curative effect of the shunt embolization was assessed by DSA at one or two months after the treatment. The relevant factors influencing the prognosis of embolization were analyzed by using univariate and multivariate Cox regression analysis methods. Results Of the 62 patients, arterioportal shunting (APS) was detected in 44, hepatic arterio-venous shunting (HAVS) in 11, APS together with HAVS in 4, and hepatic artery-pulmonary artery shunting (HAPAS) in 3. Re-examination with DSA was carried out in 53 patients at 1 - 2 months after the treatment , which showed that the shunting disappeared in 18 cases, obvious reduction of the shunt flow was seen in 19 cases, the lesion remained stable in 9 cases and the disease became worse in 7 cases. Univariate analysis indicated that the kind of embolic material and the presence of tumor thrombus could affect the obstructive result of the shunt , while multivariate Cox regression analysis showed that portal tumoral thrombus was an independent risk factor. The embolization effect of polyvinyl alcohol (PVA) particles and Lipiodol-ethanol mixture, used as the embolic agents, was better than that of gelatin sponge particles. Conclusion To ensure a successful interventional chemoembolization for HCC combined with AVS the procedure should be individualized according to the type and extent of the arteriovenous shunting. The type of embolic materials used for embolization can affect the results to a certain degree.