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摘要：
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摘要：目的 探讨肝细胞癌合并周围型动-门静脉瘘（artery-portal fistula，APF）介入治疗方案及效
果。方法 选取2009年8月至2016年9月于首都医科大学附属北京地坛医院诊治的肝细胞癌合并周围
型动-门静脉瘘（artery-portal fistula，APF）患者82例为研究对象。所有患者均经肝动脉化学栓塞
（transcatheter arterial chemoembolization，TACE）治疗，根据术中造影显示的分流量选择1～2种栓塞
剂，常用的栓塞剂为碘化油、罂粟乙碘油、明胶海绵颗粒栓塞剂（1400～2000 μm），均用洛铂稀释
后化疗灌注，观察并比较患者治疗后的疗效。结果 介入治疗前合并食管胃底静脉曲张者51例，中度
至重度腹水者30例，门静脉癌栓者41例，治疗后11例患者腹水症状消失，17例患者腹水明显减少。65
例（79.3%）患者APF瘘口术后完全消失，11例（13.4%）瘘口部分闭合，15例患者术后继续治疗中发
现APF瘘口再次复发，11例患者出现新的APF。52例（63.4%）患者肿瘤明显缩小，19例（23.3%）肿
瘤增大，11例（13.4%）肿瘤无明显变化。术前59例甲胎蛋白阳性患者介入治疗后41例甲胎蛋白水平
下降。术后有4例患者出现上消化道出血。随访中61例病死患者的中位生存期为11.4个月。结论 对于
肝细胞癌合并周围型APF患者，应根据不同分流量选择合理的栓塞剂，可有效缓解患者临床症状并提
高生活质量，最大程度降低术后并发症。
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Abstract: Objective To investigate the effects of interventional therapy for hepatocellular carcinoma with
peripheral artery-portal fistula (APF). Methods Total of 82 hepatocellular carcinoma patients with artery-
portal fistula in Beijing Ditan Hospital, Capital Medical University from August 2009 to September 2016
were selected. All patients were given transcatheter arterial chemoembolization (TACE) therapy. According
to the different flow rate showed by intraoperative angiography, 1～2 kinds of embolization agents were
selected. Common embolic agents included lipidol, ethiodized poppyseed oil and spongia gelatinosa particle
(1400～2000 μm). The effects after treatment were compared. Results Before treatment, 51 cases were with
esophageal gastric varices, 30 cases were with moderate to large ascites, and 41 cases were with portal vein
tumor thrombus. After treatment, the ascites symptoms disappeared in 11 cases and significantly decreased in
17 cases. There were 11 (13.4%) cases whose fistula was partially closed, 15 patients whose shunts reopened
in later therapy and 11 patients emerged new shunts. There were 52 (63.4%) cases whose tumors volume
decreased, 19 (23.3%) cases whose tumors volume increased and 11(13.4%) cases whose tumors volume
had no significant change. Before treatment, there were 59 cases with positive alpha fetoprotein (AFP), and
after treatment, the levels of AFP in 41 patients decreased. Total of 4 cases occurred postoperative upper
gastrointestinal bleeding. The median survival period of 61 patients with death during follow-up was 11.4
months. Conclusion For hepatocellular carcinoma patients with peripheral artery-portal fistula, different
embolic agents should be selected according to flow rate so as to relieve the clinical symptoms, and to
improve the quality of life and reduce the postoperative complications of the patients.
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