Digital subtraction angiography manifestation and interventional therapy of arteriovenous shunting in primary hepatocellular carcinoma of advanced stage / 北京大学学报(医学版)

ABSTRACT

Objective:To explore the appearances o f digital subtraction angiograph y (DSA) and therapeutic efficacy of interventional therapy of hepatic carcinoma accompanied with arteriovenous shunting (AVS). Methods: To retro spectively analy ze clinical material of 97 patients with hepatocellular carcinoma with hepatic artery-portal vein shunting(HA-PVS) , of whom, 16 had upper gastrointestinal hemorrhage, 51 had middle to l arge amounts of ascites, and 53 had varices of esophagus and fundus gastricus . All the patients were treated with transcatheter arterial chemoembolization (TACE) or transcatheter arterial infusion chemotherapy (TAI). Shunts were embolized by lipidol i n 40 patients, by lipidol and spon-gia gelatinosa particle in 34 patients, and by coi l in 6 patients. The remaining 17 were treated only with TAI. Results:Twelve (12.4%) case s had hepatic artery-hepatic vein shunting (HA-HVS),while 32 (33%)cases had portal vein tumor thrombosis (PVTT). In 70(72.2%) patients, all shunts we r e completely closed successfully, in 15(15.5%) patients, the shunts were partly closed, and in 12(12.3%)patients, the shunts were not closed. In 12 patients, the shunts reopened in later therapy, their blood flow was smaller than before and they were closed after second embolization. In 17 patients, new shunts emerged. After TACE therapy,the tumors were smaller in 57(58.7%),bi gger in 24 (24.7%),and 16(16.5%) were the same in size before and after TACE. Ascit es disappeared in 29 patients, decreased in 18 patients and had no change in 4 pati ents. Five patients who had upper gastrointestinal hemorrhage pre-operation had n ew hemorrhage. Of the 47 patients who had diarrhea, 23 improved. In 67 alph a fetoprotein (AFP) positive patients, degree of AFP in 53 patients decreased. Eighty-one patients died and their Corresp onding author’s e-mail, renjieyang2007@163.commiddle survival period was 12.9 months. No serious dama ge to hepatic function due to the treatment was observed in most patients. Concl usionPrimary hepatic carcinoma with AVS increases difficulty of interv entional therapy,but as long as we take active and proper treating measure,we could ac quire satisfactory curative effect without serious syndrome. DSA can demonstrate the type, the site and the degree of AVS completely and directly, thus having import ant value in treating primary hepatic carcinoma and improving prognosis.