【摘要】 目的　纠正成人肝海绵状血管瘤 (CHL)罕见并发动静脉短路 (AVS)的传统认识 ,提高其DSA诊断率。方法　回顾性分析确诊为CHL且不伴有其他肝脏疾患和肝损伤的 30例成人患者的DSA图像 ,并与其中并发AVS的 2 1例行经导管动脉碘油栓塞术 (L TAE)后的即时X线片进行对比 ,通过观察碘油的沉积分布状况再次验证DSA显示的AVS。结果　 30例中 2 2例 (73% )获得DSA明确诊断的AVS ,皆出现于瘤周肝组织 ,DSA动脉期表现为双轨征、早显的细小引流静脉等。 2 2例并发AVS中的 2 1例L TAE术后即时X线摄片显示 :碘油通过未完全闭塞的AVS再充盈于少数门静脉周围支或引流静脉者 11例 ,DSA显现AVS完全闭塞而未见任何静脉充盈碘油者 10例。 30例中 8例未见肯定的AVS ,其中 6例是由于DSA成像技术应用不当。结论　AVS并非肝脏恶性肿瘤的一个诊断依据 ,也常并发于成人多见的良性CHL。DSA成像技术应用适当和高质量的图像有利于显示CHL并发的细小AVS。CHL并发的AVS可能与瘤旁肝组织的病理改变有密切关系 ,但有关其形成机制有待进一步研究。更多还原

【Abstract】 Objective To correct the misunderstanding that arteriovenous shunts (AVS) are rarely found in adult cavernous hemangiomas of the liver(CHL) and to increase its diagnosis rate by DSA. Methods DSA examination and DSA images of thirty adults with definitely diagnostic CHL and without evidence of other hepatic diseases and hepatic injury were analyzed retrospectively. X ray films of 21 cases with AVS taken immediately after transcatheter arterial embolization using lipiodol (L TAE) were compared with the corresponding DSA images to check up those AVS opacified in DSA by observing sediment and distribution of iodized oil injected. Results Definite diagnosis of AVS by DSA were obtained in 22 cases of this series(73%). All the AVS were located in the peritumoral parenchyma and appeared as parellel track sign, and early opacification of small draining veins,etc.during arterial phase of DSA. X ray films taken immediately after L TAE in 21 of 22 cases with AVS showed that few portal radicles or draining veins were refilled by iodized oil through incompletely occluded shunts in 11 cases, and no any vein was refilled by iodized oil resulted from complete occlusion of the present AVS in 10. No definite AVS was found in the other 8 cases of this series, and in 6 of them improper imaging factors of DSA were used. Conclusion This study serves to emphasize that AVS is not a diagnosis of hepatic malignancy, but is frequently seen in the commonly benign CHL of adults. Proper imaging factors of DSA and superior images can be helpful to opacify small AVS of CHL. The formation of AVS in CHL may be closely related to the pathological changes of peritumoral parenchyma, however, its mechanism must be further studied.更多还原