目的 探讨采用无水乙醇明胶海绵混合物(ESG)联合化疗药物和/或碘化油,对合并中重度肝动脉门静脉分流(APS)的肝癌(HCC)患者行末梢性化疗栓塞的安全性和有效性.方法 回顾性分析2008年6月至2015年12月使用ESG栓塞治疗106例HCC合并中重度APS患者的临床资料,对于手术前后APS改善情况、手术相关并发症、肿瘤反应、生存期和预后因素等进行统计学分析.结果 106例HCC合并中重度APS的患者中位生存期为278 d,6、12、18个月累积生存率分别为70.8％、36.1％、16.0％.单因素分析结果显示:性别、总胆红素水平、最大肿瘤直径、既往治疗、治疗有无应答以及APS改善与患者预后相关.多因素分析结果显示:治疗有应答、APS改善是独立保护因素,而女性、最大肿瘤直径≥5 cm为独立危险因素.结论 采用ESG栓塞治疗合并中重度APS的HCC患者安全、有效,治疗有应答、APS改善患者预后较好,而女性、最大肿瘤直径≥5 cm为患者预后危险因素.%Objective To evaluate the safety and efficacy of peripheral chemoembolization by using ethanol-soaked gelatin sponge (ESG) combined with chemotherapeutic drugs and/or iodized oil in treating patients with hepatocellular carcinoma (HCC) complicated by moderate-to-severe hepatic arterio-portal shunts (APS).Methods The clinical data of 106 HCC patients associated with moderate-to-severe APS,who were treated with ESG chemoembolization during the period from June 2008 to December 2015,were retrospectively analyzed.The postoperative improvement of APS,the procedure-related complications,the tumor response,the survival time,the prognostic factors,etc.were statistically analyzed.Results In the 106 HCC patients associated with moderate-to-severe APS,the median survival time was 278 days,and the 6-,12-and 18-month cumulative survival rates were 70.8％,36.1％ and 16％,respectively.Univariate analysis showed that sex,total bilirubin level,maximal tumor diameter,history of previous treatment,tumor response and postoperative improvement of APS were closely correlated with the patient's prognosis.Multivariate regression analysis indicated that tumor response and postoperative improvement of APS were the independent protection factors,while the female sex and the maximal tumor size ≥5 cm were the independent risk factors.Conclusion For the treatment of HCC complicated by moderate-to-severe hepatic APS,transarterial chemoembolization by using ESG combined with chemotherapeutic drugs and/or iodized oil is safe and effective.The presence of tumor response to treatment and the postoperative improvement of APS indicate a better prognosis.The female sex and the maximal tumor size ≥5 cm are the independent prognostic risk factors.
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