摘要
目的:探讨化疗栓塞治疗原发性肝癌合并肝动静脉瘘(HAVS)的临床疗效及影响预后的因素。方法:67例不能手术切除的原发性肝癌合并HAVS患者行化疗栓塞治疗,观察HAVS栓塞效果及近期、远期疗效。应用Kaplan-Meier法、Log-rank检验进行患者的生存率分析,Cox回归模型进行多因素分析。结果:67例HAVS中肝动脉-门静脉瘘59例,肝动脉-肝静脉瘘8例;轻、中度动静脉瘘53例,重度动静脉瘘14例。HAVS完全栓塞44例(65.7%),轻、中度动静脉瘘的完全栓塞率(73.6%,39/53)高于重度动静脉瘘(35.7%,5/14),差异有统计学意义(χ~2=7.04,P=0.008)。67例患者中,完全缓解(CR)2例,部分缓解(PR)29例,疾病稳定(SD)30例,疾病进展(PD)6例,总有效率为46.7%(31/67)。67例患者1年生存率为49.3%,中位生存期为11.0个月。单因素分析结果显示肿瘤大小(<8cm/≥8cm)、血管瘤栓(有/无)、术前AFP水平(<400/≥400ng/mL)、碘油沉积类型(Ⅰ+Ⅱ/Ⅲ)、瘘口栓塞效果(瘘消失/未消失)的生存率差异有统计学意义(P<0.05),Cox模型多因素分析显示肿瘤大小、碘油沉积类型是生存率的独立预后因素。结论:化疗栓塞治疗原发性肝癌合并HAVS有效,肿瘤大小、碘油沉积类型是独立的预后因素。
Objective：To investigate the effect of transcatheter arterial chemoembolization （TACE） in primary hepatic carcinoma combined with hepatic arteriovenous shunt （HAVF） and factors influencing the prognosis. Methods：From November 2013 to January 2015,67 patients with inoperable primary hepatic carcinoma combined with hepatic arteriovenous shunt were treated by TACE. The effect of chemo-embolization on arterioportal shunt,the short-term effect and long-term effect were observed. Kaplan-Meier method,the cumulative survival rates and multivariate Cox proportional hazard model were used to analyze the survival prognostic factors. Results：Of a total of 67 cases of HAVS,there were 59 cases of hepatic arterioportal shunt and 8 cases of hepatic arteriovenous shunt respectively. 53 cases were mild-to-moderate shunt and 14 cases were severe shunt. 44 cases of HAVF were completely occluded,and the embolization rate of mild-to-moderate shunt was significantly better than that of severe shunt （χ2 = 7.04,P = 0. 008）. Complete remission,partial remission,stable disease and progressive disease were obtained in 2,29,30 and 6,respectively. The overall effective rate was 46.7%.The 1 year survival rate and median survival time were 49.3% and 11.0 months respectively. Log-rank analysis showed that tumor size, tumor thrombosis, preoperative AFP level, the type of lipiodol retention and the effect of embolization on HAVS were the factors affecting prognosis. Multivariable analysis showed that tumor size and the type of lipiodol retention were the independent prognostic factors of survival rate. Conclusion：Transcatheter arterial chemoembolization is an effective method of treatment in primary hepatic carcinoma combined with HAVS. Tumor size and the type of lipiodol retention are the independent prognostic factors.
出处
《放射学实践》
北大核心
2017年第5期529-532,共4页
Radiologic Practice
关键词
肝肿瘤
动静脉瘘
肝动脉化疗栓塞术
预后
Liver neoplasms
Arteriovenous fistula
Transcatheter arterial chemoembolization
Prognosis
