Furuse J, Iwasaki M, Yoshino M, Konishi M, Kawano N, Kinoshita T, Ryu M, Satake M, Moriyama N
Department of Internal Medicine, National Cancer Center Hospital, Chiba, Japan.
Radiology. 1997 Sep;204(3):787-90. doi: 10.1148/radiology.204.3.9280260.
To evaluate transcatheter arterial embolization in patients with hepatocellular carcinoma, portal vein tumor thrombus, and arterioportal shunts.
Ten patients with hepatocellular carcinoma, portal vein tumor thrombus, and severe arterioportal shunting were identified; in these patients, portal blood flow before embolization was hepatofugal. Embolization of arterioportal shunts was performed with steel coils that were introduced through a catheter during arteriography. After embolization, changes in portal hemodynamics and clinical signs and performance status of patients were evaluated; survival rates of patients with and patients without severe arterioportal shunting were compared.
In all patients after embolization, angiography showed resolution of arterioportal shunting, and portography showed hepatopetal blood flow in the portal vein trunk. After embolization, performance status of five patients with initial scores of 2 or 3 improved. Ascites resolved in four patients and improved in four patients. One patient died of hepatic failure caused by rupture of esophageal varices 7 days after embolization. Median survival was 4.3 months, and the 6-month and 1-year survival rates were 45% and 12%, respectively. There were no significant differences between survival rates in patients with and patients without severe arterioportal shunting.
Transcatheter arterial embolization of arterioportal shunts is a useful treatment for improving quality of life in patients with hepatocellular carcinoma.
评估经导管动脉栓塞术在肝细胞癌合并门静脉瘤栓及动门脉分流患者中的应用。
确定10例肝细胞癌合并门静脉瘤栓及严重动门脉分流的患者；这些患者在栓塞前门静脉血流为离肝血流。在动脉造影期间，通过导管引入钢圈对动门脉分流进行栓塞。栓塞后，评估门静脉血流动力学变化以及患者的临床体征和功能状态；比较有严重动门脉分流和无严重动门脉分流患者的生存率。
所有患者栓塞后，血管造影显示动门脉分流消失，门静脉造影显示门静脉主干向肝血流。栓塞后，初始评分2或3分的5例患者功能状态改善。4例患者腹水消退，4例患者腹水改善。1例患者在栓塞后7天死于食管静脉曲张破裂导致的肝衰竭。中位生存期为4.3个月，6个月和1年生存率分别为45%和12%。有严重动门脉分流和无严重动门脉分流患者的生存率之间无显著差异。
经导管动脉栓塞动门脉分流术是改善肝细胞癌患者生活质量的有效治疗方法。
