本文選題：肝癌　切入點(diǎn)：肝動(dòng)脈-門靜脈瘺　出處：《山西醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：1.觀察原發(fā)性肝癌合并肝動(dòng)脈-門靜脈瘺的DSA表現(xiàn)； 2.探討不同類型肝動(dòng)脈合并門靜脈瘺的介入治療的方法及療效。 方法：選取我院2011年7月至2013年6月間68例肝癌患者，經(jīng)病理學(xué)、影像學(xué)、實(shí)驗(yàn)室檢查等診斷為原發(fā)性肝癌，同時(shí)證實(shí)合并肝動(dòng)脈-門靜脈瘺，并實(shí)施了介入手術(shù)治療。在術(shù)前均進(jìn)行DSA檢查，并經(jīng)臨床經(jīng)驗(yàn)豐富的專家對(duì)DSA進(jìn)行分析和制定介入治療的方法。分析不同類型肝動(dòng)脈-門靜脈瘺的DSA顯像和相應(yīng)的介入方法。對(duì)比分析介入手術(shù)前后實(shí)驗(yàn)室檢查指標(biāo)和影像學(xué)指標(biāo)。 結(jié)果：1.原發(fā)性肝癌合并肝動(dòng)脈-門靜脈瘺DSA表現(xiàn)，門靜脈主干及分支在DSA肝動(dòng)脈期顯影。中央型表現(xiàn)為DSA動(dòng)脈期腫瘤染色出現(xiàn)在門脈顯影后，門脈顯影在主干和較大分支。周圍型表現(xiàn)為門脈分支在動(dòng)脈期的顯影，并可出現(xiàn)門脈分支與肝動(dòng)脈并行的雙軌征�；旌闲蛢烧咛卣骶沙霈F(xiàn)。 2.中央型肝動(dòng)脈-門靜脈瘺的患者首先超過瘺口，在腫瘤組織中注入適量的碘油和化療藥物的混合劑，再用明膠海綿和(或)彈簧圈將瘺口栓塞后，繼續(xù)注入適量的碘油和化療藥物的混合劑栓塞腫瘤；周圍型肝動(dòng)脈-門靜脈瘺的患者首先用明膠海綿顆粒將小瘺口栓塞，，后注入適量的碘油和化療藥物的混合劑栓塞腫瘤；混合型可將上述方法靈活運(yùn)用，68例患者均治療成功。術(shù)后大多數(shù)患者出現(xiàn)腹部疼痛、不同程度的惡心、嘔吐，考慮為介入治療中微創(chuàng)及化療藥物所致，給予對(duì)癥處理后均恢復(fù)。部分患者出現(xiàn)體溫升高，給予物理和藥物降溫后均緩解，不考慮感染所致。 結(jié)論：1.DSA明確診斷肝癌合并肝動(dòng)脈-門靜脈瘺的部位、類型及侵犯程度，同時(shí)為介入治療提供可靠的依據(jù)。 2.采用針對(duì)性肝動(dòng)脈化療栓塞術(shù)對(duì)各型肝癌合并肝動(dòng)脈-門靜脈瘺進(jìn)行栓塞治療，同時(shí)可以對(duì)原發(fā)腫瘤進(jìn)行積極治療。 3.針對(duì)性肝動(dòng)脈化療栓塞術(shù)治療肝癌合并肝動(dòng)脈-門靜脈瘺提高療效，提高病人生活質(zhì)量。
[Abstract]:Objective 1. To observe the DSA features of primary liver cancer with hepatic arterial-portal vein fistula. 2. To investigate the interventional treatment of hepatic artery complicated with portal vein fistula. Methods: from July 2011 to June 2013, 68 patients with liver cancer were diagnosed as primary liver cancer by pathology, imaging and laboratory examination. Interventional surgery was performed. DSA was performed before operation. The DSA imaging of different types of hepatic arterial-portal vein fistula and the corresponding interventional methods were analyzed. The laboratory examination before and after interventional operation was compared and analyzed. Indicators and imaging indicators. Results 1. DSA findings of primary liver cancer complicated with hepatic arterio-portal fistula, portal vein trunk and branches developed in DSA hepatic artery phase, central type showed that DSA arterial phase tumor staining appeared after portal vein development. The development of portal vein in the main trunk and the larger branch. The peripheral type showed the development of the portal vein branch in the arterial phase, and the double track sign of the portal vein branch and the hepatic artery could be seen. 2. The patients with central hepatic arterial-portal vein fistula first passed the fistula, injected a suitable amount of lipiodol and chemotherapeutic agents into the tumor tissue, and then embolized the fistula with gelatin sponge and / or coils. The tumor was embolized with a mixture of lipiodol and chemotherapeutic agents. The small fistula was embolized with gelfoam granules and then embolized with a mixture of lipiodol and chemotherapeutic agents. Most of the patients developed abdominal pain, nausea and vomiting in varying degrees after the operation. They were considered to be caused by minimally invasive and chemotherapeutic drugs in the interventional therapy. Some of the patients had elevated body temperature and were relieved by physical and drug cooling, regardless of infection. Conclusion: 1. DSA can clearly diagnose the location, type and degree of invasion of hepatic carcinoma complicated with hepatic arterial-portal vein fistula, and provide reliable basis for interventional therapy. 2. Hepatic arterial chemoembolization was used to treat various types of liver cancer with hepatic arterial-portal vein fistula, and the primary tumor could be treated actively. 3. The therapeutic effect of hepatic arterial chemoembolization combined with hepatic arterial-portal vein fistula was improved and the quality of life was improved.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.7;R730.44

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相關(guān)碩士學(xué)位論文 前1條

1 李元;肝癌合并肝動(dòng)脈—門靜脈瘺DSA表現(xiàn)及介入治療分析[D];山西醫(yī)科大學(xué);2014年

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