【作者】 罗鹏飞； 陈晓明； 陆骊工； 胡宝山； 李勇；

【机构】 广东省人民医院肿瘤中心；

【摘要】 目的:研究肝癌合并肝动脉门静脉瘘(HAPVF)时门静脉压力(PVP)升高的血流动力学以及由此而致的顽固性上消化道出血的诊断和治疗。方法:115例肝癌合并上消化道出血者均行肝动脉造影,其中发现严重的肝动脉门静脉瘘者用钢圈和／或无水酒精行瘘口栓塞术。结果:31例顽固性上消化道出血肝癌患者中26例有严重的HAPVF(门静脉主干显影),而84例较轻的上消化道出血者仅15例有轻度的HAPVF (门静脉主干不显影)。26例严重的HAPVF者栓塞术后分流减轻或消失,其中两例肝动脉主干闭塞,5例分流减轻。所有 26例治疗后上消化道出血停止。结论:肝癌出现顽固性上消化道出血时要考虑严重的HAPVF存在,肝动脉DSA可作出诊断。瘘口栓塞术是治疗此类型出血的最有效的方法。更多还原

【Abstract】 Objective: To investigate the haemodynamics of increasing portal venous pressure (PVP) in hepatocellular carcinoma patients complicated with hepatic artery-portal vein fistulas(HAPVF) and the diagnosis and therapy of intractable upper gastrointestinal hemorrhage caused by HAPVF. Methods: 115 cases of hepatocellular carcinoma with upper gas- trointestinal hemorrhage were checked by hepatic arteri-ography and were treated through orifices embolization in cases with sever HAPCF by coils and/or ethanol. Results: 26 out of 31 patients suffering intractable upper gastrointestinal hemorrhage have severe HAPVF (the main stem of portal veins are visible).However, there are only 15 patients with light HAPVF among the 84 patients who have mild upper gastrointestinal hemorrhage( the main stem of portal veins are invisible).After the embolization, all of the 26 patients who have severe HAPVF stopped bleeding .Among them, the main stem of hepatic arteries are occluded in 2 patients,and the shunts reduced in 5 patients. Conclusion: The existence of severe HAPVF should be taken into consideration when intractable upper gastrointestinal hemorrhage occurrs in hepatocellular carcinoma patients ,and it can be diagnosed through hepatic artery DSA. Orifice embolization is the most effective method for such kind of hemorrhage.更多还原