Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
Cardiovasc Intervent Radiol. 2013 Apr;36(2):412-21. doi: 10.1007/s00270-012-0410-4. Epub 2012 May 12.
To evaluate the efficacy and safety of cyanoacrylate glue embolization in the treatment of severe arterioportal shunt (APS) presenting with hepatofugal portal venous flow in hepatocellular carcinoma (HCC) patients.
Between July 2000 and January 2010, 27 HCC patients with severe APS presenting with hepatofugal portal venous flow underwent transarterial angiography and treatment. Among them, four patients were excluded from the study. Twelve patients underwent transarterial chemoperfusion and embolization of APS with cyanoacrylate glue between January 2006 and January 2010 (Emb group), and the other 11 patients undergoing only transarterial chemoperfusion without embolization of APS between July 2000 and December 2005 served as a control group (non-Emb group). The change of APS, survival rates, and procedure related complications were analyzed.
In the Emb group, APS was improved in all of the 12 patients after initial glue embolization; long-term APS improvement with hepatopetal portal flow was achieved in 80 % (8 of 10) patients who underwent follow-up angiography. Survival rates in the Emb group were 67 % at 6 months, 33 % at 1 year, and 8 % at 2 years, whereas those in the non-Emb group were 0 % at 6 months (P < 0.05). Median survival time in the Emb group was 275 days, which was longer than that of 107 days in the non-Emb group (P = 0.001). There were no major complications in both groups.
The preliminary experience suggests that glue embolization may be an effective and safe therapy in the management of severe APS accompanied by HCC and also improve patient survival.
评估氰基丙烯酸酯胶栓塞治疗伴有肝外门静脉血流的肝细胞癌（HCC）患者严重动静脉分流（APS）的疗效和安全性。
2000 年 7 月至 2010 年 1 月，27 例伴有肝外门静脉血流的 HCC 严重 APS 患者行经动脉血管造影和治疗。其中，4 例患者被排除在研究之外。12 例患者于 2006 年 1 月至 2010 年 1 月接受经动脉化疗栓塞治疗 APS 用氰基丙烯酸酯胶（Emb 组），11 例患者仅接受经动脉化疗而不栓塞 APS 作为对照组（非 Emb 组），于 2000 年 7 月至 2005 年 12 月。分析 APS 的变化、生存率和与操作相关的并发症。
在 Emb 组，12 例患者初次胶栓塞后 APS 均有改善；80%（8/10）行随访血管造影的患者获得长期 APS 改善和肝内门静脉血流。Emb 组的 6 个月、1 年和 2 年生存率分别为 67%、33%和 8%，而非 Emb 组分别为 0%（P<0.05）。Emb 组的中位生存时间为 275 天，长于非 Emb 组的 107 天（P=0.001）。两组均无重大并发症。
初步经验表明，胶栓塞可能是治疗伴有 HCC 的严重 APS 的有效、安全的治疗方法，也能提高患者的生存率。
