肝细胞癌合并动-门静脉瘘的诊治进展

杨洋; 郭武华

doi:10.3969/j.issn.1001-5256.2017.02.036

肝细胞癌合并动-门静脉瘘的诊治进展

DOI: 10.3969/j.issn.1001-5256.2017.02.036

杨洋,
郭武华

南昌大学第二附属医院消化内科

基金项目:

国家自然科学基金资助项目(91029720)；

详细信息

中图分类号: R735.7
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出版历程
- 收稿日期: 2016-10-10
- 出版日期: 2017-02-20

Research advances in diagnosis and treatment of hepatocellular carcinoma complicated by arterioportal shunt

Department of Gastroenterology,The Second Affiliated Hospital of Nanchang University

Research funding:

摘要

摘要: 肝细胞癌合并肝动-门静脉瘘（APS）临床常见,发生率约28.8%63.2%。可表现为腹痛、腹泻和腹水,也可引起消化道出血等严重门静脉高压的并发症。尽管治疗方法多样,但总体疗效较差,是肝癌患者死亡的重要原因之一。介绍了肝癌合并APS的病因、分型、临床表现、治疗方法。认为虽然目前肝癌合并APS的治疗方法很多,但介入治疗仍是主要治疗手段,随着对介入治疗方法的不断探索,患者的预后也得到很大的提高。
- 癌,肝细胞 /
- 动静脉瘘 /
- 诊断 /
- 治疗 /
- 综述
Abstract: Hepatocellular carcinoma( HCC) complicated by arterioportal shunt( APS) is commonly seen in clinical practice,with an incidence rate of 28.8%- 63.2%.It is manifested as abdominal pain,diarrhea,and ascites and can also lead to serious complications of portal hypertension including gastrointestinal bleeding.Although there are various therapeutic methods,they tend to have poor clinical effects.APS is one of the most important causes of death in patients with HCC.This article introduces the etiology,typing,clinical manifestation,and therapies of HCC complicated by APS and points out that although there are various therapeutic methods for HCC complicated by APS,interventional treatment remains the most important method.The exploration of interventional treatment helps to improve patients' prognosis.
- carcinoma /
- hepatocellular /
- arteriovenous fistula /
- diagnosis /
- therapy

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参考文献(30)

[1]FORNER A,LLOVET JM,BRUIX J.Hepatocellular carcinoma[J].Lancet,2012,379(9822):1245-1255.

[2]VENOOK AP,PAPANDREOU C,FURUSE J,et al.The incidence and epidemiology of hepatocellular carcinoma:a global and regional perspective[J].Oncologist,2010,15(Suppl 4):5-13.

[3]BRUIX J,SHERMAN M.Management of hepatocellular carcinoma[J].Hepatology,2005,42(5):1208-1236.

[4]KANOGAWA N,CHIBA T,OGASAWARA S,et al.Successful interventional treatment for arterioportal fistula caused by radiofrequency ablation for hepatocellular carcinoma[J].Case Rep Oncol,2014,7(3):833-839.

[5]TUO L,TANG SH,ZENG WZ,et al.Treatment and prevention strategies to complications of transjugular intrahepatic portosystemic shunt[J].J Clin Hepatol,2016,32(2):354-357.(in Chinese)庹琳,汤善宏,曾维政,等.经颈静脉肝内门体分流术并发症的处理及预防措施[J].临床肝胆病杂志,2016,32(2):354-357.

[6]FANG Y,LONG QY,LIU JF,et al.Exploration of interventional therapeutic pattern for hepatocellular carcinoma associated with hepatic arterioportal fistulae[J].J Int Rad,2010,19(10):776-779.(in Chinese)方瑜,龙清云,刘骏方,等.肝癌合并肝动脉-肝门静脉瘘介入治疗方式的探讨[J].介入放射学杂志,2010,19(10):776-779.

[7]LUO JH,ZHOU JX,JIANG RJ,et al.The clinical significance of interventional cure to the change of blood flow of arteriovenous shunting in primary hepatocellular carcinoma[J].Chin J Hemorrheol,2007,17(1):95-97.(in Chinese)骆江红,周经兴,江容坚,等.介入处理肝癌并动静脉瘘的血流改变的临床意义[J].中国血液流变学杂志,2007,17(1):95-97.

[8]IBN MAJDOUB HASSANI K,MOHSINE R,BELKOUCHI A,et al.Post-traumatic arteriovenous fistula of the hepatic pedicle[J].J Visc Surg,2010,147(5):333-336.

[9]CHEN LJ,YANG RJ,ZHU LZ,et al.Imaging characteristics and intervention therapy for hepatic artery-portal vein shunts in patients with primary liver carcinoma[J].Chin J Clin Onc,2015,42(11):570-575.(in Chinese)陈立军,杨仁杰,朱林忠,等.原发性肝癌介入术中肝动脉-门静脉瘘的影像学特点及治疗[J].中国肿瘤临床,2015,42(11):570-575.

[10]HERNANDEZ M,GONZALEZ I,LLOP E,et al.Arterioportal fistula,a rare cause of presinusoidal portal hypertension[J].Gastroenterol Hepatol,2016,39(1):43-45.

[11]TANG XY,WANG Z,WANG T,et al.Efficacy,safety and feasibility of ultrasound-guided percutaneous microwave ablation for large hepatic hemangioma[J].J Dig Dis,2015,16(9):525-530.

[12]GAO X,LI H,HAN X,et al.The curative effect of radiofrequency ablation on cancer of the liver and the effect of RFA on Treg cells of patients[J].J Clin Exp Med,2015,14(11):917-919.(in Chinese)高霞,李恒,韩笑,等.冷循环射频消融技术在肝细胞癌中的疗效及其对患者调节性T细胞的影响[J].临床和实验医学杂志,2015,14(11):917-919.

[13]SHAO HB,MA TC,NIU M,et al.Endovascular placement of iodine-125 seed strand combined with chemoembolization for the treatment of hepatocellular carcinoma with tumor thrombus in portal vein[J].Clin J Med Offic,2016,44(4):377-381.(in Chinese)邵海波,马腾闯,牛猛,等.碘125粒子联合肝动脉化疗栓塞术治疗原发性肝癌合并门脉分支癌栓疗效分析[J].临床军医杂志,2016,44(4):377-381.

[14]SHI H,YANG Z,LIU S,et al.Transarterial embolization with cyanoacrylate for severe arterioportal shunt complicated by hepatocellular carcinoma[J].Cardiovasc Intervent Radiol,2013,36(2):412-421.

[15] MU M,YAN W.Clinical effect of interventional embolization in treatment of primary liver cancer with hepatic arterioportal fistula[J].World Health Dig,2013,(41):230-231.(in Chinese)穆民,颜雯.介入栓塞治疗原发性肝癌合并肝动脉静脉瘘的临床疗效观察[J].中外健康文摘,2013,(41):230-231.

[16]CHAN WS,POON WL,CHO DH,et al.Transcatheter embolisation of intrahepatic arteriovenous shunts in patients with hepatocellular carcinoma[J].Hong Kong Med J,2010,16(1):48-55.

[17]HUANG MS,LIN Q,JIANG ZB,et al.Comparison of long-term effects between intra-arterially delivered ethanol and Gelfoam for the treatment of severe arterioportal shunt in patients with hepatocellular carcinoma[J].World J Gastroenterol,2004,10(6):825-829.

[18]LIU S,SHI HB,YANG ZQ,et al.The clinical value of treatment for hepatocellular carcinoma complicated with arterio-portal fistula wing N-butyl 2-cyanoacrylate[J].Chin J Rad,2009,43(3):279-283.(in Chinese)刘圣,施海彬,杨正强,等.α-氰基丙烯酸正丁酯栓塞治疗肝细胞癌并肝动脉-门静脉瘘的临床价值[J].中华放射学杂志,2009,43(3):279-283.

[19]SONDMURA T,KAWAI N,KISHI K,et al.N-butyl cyanoacrylate embolization with blood flow control of an arterioportal shunt that developed after radiofrequency ablation of hepatocellular carcinoma[J].Korean J Radiol,2014,15(2):250-253.

[20]MURATA S,TAJIMA H,NAKAZAWA K,et al.Initial experience of transcatheter arterial chemoembolization during portal vein occlusion for unresectable hepatocellular carcinoma with marked arterioportal shunts[J].Eur Radiol,2009,19(8):2016-2023.

[21]TAKAO H,SHIBATA E,OHTOMO K.Double-balloon-assisted n-Butyl-2-Cyanoacrylate embolization of intrahepatic arterioportal shunt prior to chemoembolization of hepatocellular carcinoma[J].Cardiovasc Intervent Radiol,2016,39(10):1479-1483.

[22]KIM SK,CHUN HJ,CHOI BG,et al.Transcatheter venous embolization of a massive hepatic arteriovenous shunt complicating hepatocellular carcinoma using an amplatzer vascular plug[J].Jpn J Radiol,2011,29(2):156-160.

[23]ZAIDI N,OKOH A,YIGIGBAS H,et al.Laparoscopic microwave thermosphere ablation of malignant liver tumors:an analysis of 53cases[J].J Surg Oncol,2016,113(2):130-134.

[24]ZHOU ZB,LI YJ.Curative observation of ultrasound-guided microwave ablation therapy for hepatocellular carcinoma combined with arterio-venous fistula[J].Chin J Ultr,2015,24(11):968-971.(in Chinese)周忠斌,李永杰.超声引导微波消融治疗原发性肝癌合并动静脉瘘的疗效观察[J].中华超声影像学杂志,2015,24(11):968-971.

[25]ZHANG YY,GU YK,HUANG JH,et al.Effect analysis of multi-electrode synchronous radiofrequency ablation and conventional single electrode overlapping ablation[J].Nat Med J Chin,2015,95(43):3537-3540.(in Chinese)张艳阳,顾仰葵,黄金华,等.多电极同步射频消融与常规单电极重叠射频消融效果的实验观察[J].中华医学杂志,2015,95(43):3537-3540.

[26]PUA U.High-flow arterio-hepatic venous shunt in hepatocellular carcinoma:use of multi-electrode radiofrequency for shunt obliteration[J].Cardiovasc Intervent Radiol,2015,38(5):1330-1334.

[27]HSU HC,CHEN TY,CHIU KW,et al.Three-dimensional conformal radiotherapy for the treatment of arteriovenous shunting in patients with hepatocellular carcinoma[J].Br J Radiol,2007,80(949):38-42.

[28]OH D,SHIN SW,PARK HC,et al.Changes in arterioportal shunts in hepatocellular carcinoma patients with portal vein thrombosis who were treated with chemoembolization followed by radiotherapy[J].Cancer Res Treat,2015,47(2):251-258.

[29]RATTI F,CIPRIANI F,PAGANELLI M,et al.Surgical approach to multifocal hepatocellular carcinoma with portal vein thrombosis and arterioportal shunt leading to portal hypertension and bleeding:a case report[J].World J Surg Oncol,2012,10:34.

[30]UCHZYAMA H,SHZRARE K,YOSHIZUMI T,et al.Living donor liver transplantation for intrahepatic arteriovenous fistula with hepatic artery reconstruction using the right gastroepiploic artery[J].Liver Transpl,2016,22(4):552-556.

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