肝癌合并肝动脉—门静脉瘘DSA表现及介入治疗分析

发布时间：2018-03-28 01:05

本文选题：肝癌　切入点：肝动脉-门静脉瘘　出处：《山西医科大学》2014年硕士论文

【摘要】：目的：1.观察原发性肝癌合并肝动脉-门静脉瘘的DSA表现； 2.探讨不同类型肝动脉合并门静脉瘘的介入治疗的方法及疗效。方法：选取我院2011年7月至2013年6月间68例肝癌患者，经病理学、影像学、实验室检查等诊断为原发性肝癌，同时证实合并肝动脉-门静脉瘘，并实施了介入手术治疗。在术前均进行DSA检查，并经临床经验丰富的专家对DSA进行分析和制定介入治疗的方法。分析不同类型肝动脉-门静脉瘘的DSA显像和相应的介入方法。对比分析介入手术前后实验室检查指标和影像学指标。结果：1.原发性肝癌合并肝动脉-门静脉瘘DSA表现，门静脉主干及分支在DSA肝动脉期显影。中央型表现为DSA动脉期肿瘤染色出现在门脉显影后，门脉显影在主干和较大分支。周围型表现为门脉分支在动脉期的显影，并可出现门脉分支与肝动脉并行的双轨征。混合型两者特征均可出现。 2.中央型肝动脉-门静脉瘘的患者首先超过瘘口，在肿瘤组织中注入适量的碘油和化疗药物的混合剂，再用明胶海绵和(或)弹簧圈将瘘口栓塞后，继续注入适量的碘油和化疗药物的混合剂栓塞肿瘤；周围型肝动脉-门静脉瘘的患者首先用明胶海绵颗粒将小瘘口栓塞，，后注入适量的碘油和化疗药物的混合剂栓塞肿瘤；混合型可将上述方法灵活运用，68例患者均治疗成功。术后大多数患者出现腹部疼痛、不同程度的恶心、呕吐，考虑为介入治疗中微创及化疗药物所致，给予对症处理后均恢复。部分患者出现体温升高，给予物理和药物降温后均缓解，不考虑感染所致。结论：1.DSA明确诊断肝癌合并肝动脉-门静脉瘘的部位、类型及侵犯程度，同时为介入治疗提供可靠的依据。 2.采用针对性肝动脉化疗栓塞术对各型肝癌合并肝动脉-门静脉瘘进行栓塞治疗，同时可以对原发肿瘤进行积极治疗。 3.针对性肝动脉化疗栓塞术治疗肝癌合并肝动脉-门静脉瘘提高疗效，提高病人生活质量。
[Abstract]:Objective 1. To observe the DSA features of primary liver cancer with hepatic arterial-portal vein fistula. 2. To investigate the interventional treatment of hepatic artery complicated with portal vein fistula. Methods: from July 2011 to June 2013, 68 patients with liver cancer were diagnosed as primary liver cancer by pathology, imaging and laboratory examination. Interventional surgery was performed. DSA was performed before operation. The DSA imaging of different types of hepatic arterial-portal vein fistula and the corresponding interventional methods were analyzed. The laboratory examination before and after interventional operation was compared and analyzed. Indicators and imaging indicators. Results 1. DSA findings of primary liver cancer complicated with hepatic arterio-portal fistula, portal vein trunk and branches developed in DSA hepatic artery phase, central type showed that DSA arterial phase tumor staining appeared after portal vein development. The development of portal vein in the main trunk and the larger branch. The peripheral type showed the development of the portal vein branch in the arterial phase, and the double track sign of the portal vein branch and the hepatic artery could be seen. 2. The patients with central hepatic arterial-portal vein fistula first passed the fistula, injected a suitable amount of lipiodol and chemotherapeutic agents into the tumor tissue, and then embolized the fistula with gelatin sponge and / or coils. The tumor was embolized with a mixture of lipiodol and chemotherapeutic agents. The small fistula was embolized with gelfoam granules and then embolized with a mixture of lipiodol and chemotherapeutic agents. Most of the patients developed abdominal pain, nausea and vomiting in varying degrees after the operation. They were considered to be caused by minimally invasive and chemotherapeutic drugs in the interventional therapy. Some of the patients had elevated body temperature and were relieved by physical and drug cooling, regardless of infection. Conclusion: 1. DSA can clearly diagnose the location, type and degree of invasion of hepatic carcinoma complicated with hepatic arterial-portal vein fistula, and provide reliable basis for interventional therapy. 2. Hepatic arterial chemoembolization was used to treat various types of liver cancer with hepatic arterial-portal vein fistula, and the primary tumor could be treated actively. 3. The therapeutic effect of hepatic arterial chemoembolization combined with hepatic arterial-portal vein fistula was improved and the quality of life was improved.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.7;R730.44

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