Wu Zhijuan, Zhang Min, Tian Ruirui, Liu Jibing, Chang Xu, Ning Shangkun, Yu Yingli, Zhang Lin
Department of Gerontology, Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
Department of Breast and Thyroid Surgery, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China.
BMC Gastroenterol. 2025 May 20;25(1):387. doi: 10.1186/s12876-025-03970-4.
The present study aimed to evaluate the effectiveness of spring coils or gelatin sponges for the embolization of giant hepatocellular carcinoma (HCC) with a hepatic arterioportal shunt (APS) in targeted therapy.
A total of 81 patients with a large HCC complicated with APS were divided into two groups on the basis of the use of block-APS embolic agents: the coil group and the gelatin sponge group. Both groups received lipiodol transarterial chemoembolization (TACE) after APS was correspondingly blocked with a coil or gelatin sponge. Sorafenib or lenvatinib was administered 3-5 days before TACE.
Both groups showed improvement in the incidence of fistula one month after the first TACE session and the last TACE session compared with before treatment. In addition, the improvement in the incidence of fistulas in the coil group was greater than that in the gelatin sponge group [p = 0.003], whereas the compensation of extrahepatic blood vessels was more severe in the coil group. There was no significant difference in median overall survival (OS) (11.13 months, 95% CI 7.67-14.59 months vs. 15.13 months, 95% CI 10.18-20.09 months, p = 0.303) or progression-free survival (PFS) (5.37 months, 95% CI 5.04-5.70 months vs. 5.7 months, 95% CI 0.66-10.74 months, p = 0.376) between the two groups. However, both groups showed early progression of intrahepatic lesions.
Spring coil or gelatin sponge embolization combined with APS was used for giant HCC patients, which significantly improved the incidence of fistulas.
本研究旨在评估弹簧圈或明胶海绵在靶向治疗中对伴有肝动脉门静脉分流（APS）的巨大肝细胞癌（HCC）进行栓塞的有效性。
将81例合并APS的大肝癌患者根据所使用的阻断APS栓塞剂分为两组：弹簧圈组和明胶海绵组。两组在使用弹簧圈或明胶海绵相应阻断APS后均接受碘油经动脉化疗栓塞术（TACE）。在TACE前3 - 5天给予索拉非尼或仑伐替尼。
与治疗前相比，两组在首次TACE疗程和最后一次TACE疗程后1个月时瘘管发生率均有所改善。此外，弹簧圈组瘘管发生率的改善大于明胶海绵组[p = 0.003]，而弹簧圈组肝外血管的代偿更为严重。两组的中位总生存期（OS）（11.13个月，95%CI 7.67 - 14.59个月 vs. 15.13个月，95%CI 10.18 - 20.09个月，p = 0.303）或无进展生存期（PFS）（5.37个月，95%CI 5.04 - 5.70个月 vs. 5.7个月，95%CI 0.66 - 10.74个月，p = 0.376）无显著差异。然而，两组均显示肝内病变早期进展。
弹簧圈或明胶海绵栓塞联合APS用于巨大HCC患者，显著提高了瘘管发生率。
