Interventional Treatment Of Primary Liver Cancer Complicated With Hepatic Artery Portal Vein Fistula And Its Therapeutic Effect

Background and Objective: The incidence of primary liver cancer(hepatocelluarcarcinoma, HCC) showed a rapid growth trend in the past ten years,according to the relevant statistics, it ranked sixth in the world of malignant tumors.Primary liver cancer is one of the most common malignant tumors in China. Its mortality rate ranks third in the digestive system malignant tumors, which is only second to gastric cancer and esophageal cancer, and has an increasing trend year by year [1].Primary liver cancer onset occult, clinical symptoms are obvious, most of the disease has entered the middle and late, at this time often lose surgical indications. So for patients with advanced hepatocellular carcinoma, TACE(transcatheter arterial chemoembolization, TACE) is the treatment of choice for most. According to the statistics of the European Association of liver(EASL) and transcatheter arterial chemoembolization(TACE) sure, significantly improve the patient of 3 years survival rate [2]. However there are some HCC patients for poor clinical response after TACE treatment, rapid progression, quality of life and survival of patients decreased. Hepatic artery portal vein fistula is one of the main factors.Primary hepatocellular carcinoma in celiac artery or hepatic artery angiography found patients with hepatic arterial portal fistula were not uncommon, these patients associated with portal hypertension,portal vein tumor thrombus and esophageal varices and in interventional therapy if lack of understanding, improper handling, will seriously affect the sound treatment,and thus aggravate the condition. Therefore, according to the different manifestations of the fistula and other imaging signs, we should choose the correct method of interventional treatment to get better therapeutic effect.Methods: Retrospective analysis of Tumor Hospital of Shandong Province in2012 to 2015 were 95 cases of primary hepatocellular carcinoma patients with clinical and pathological data, this study were selected in 95 patients with, 64 cases of male,female 31 cases, age 36 to 71 years old, average 55.1 years, interventional occlusion of the fistula 80 cases classified as embolism group, 15 cases of patients withangiographically found hepatic artery portal vein fistula only Tai classified as non embolic group. the clinical data and imaging analysis, follow-up after interventional therapy in patients with clinical symptoms to improve the situation in order to evaluate the short-term clinical the improvement of symptoms; compared with X2 exact test by different ways of occlusion occlusion close fistula postoperative rate; the single factor analysis of hepatic artery portal vein fistula with gender, age, tumor type,location, background of liver cirrhosis(liver and non liver door door), the correlation of portal vein tumor thrombus, and further multivariate Logistic regression analysis to identify risk factors for the formation of hepatic artery portal vein fistula or independent risk factors. The recurrence of fistula and the survival period of the patients were followed up. The risk factors of the fistula were analyzed. Finally,summarize the clinical experience in the process of interventional embolization and discuss the method of plugging the different types of fistula.Resluts: 1. patients with different clinical symptoms of hepatic artery portal vein fistula patients, after interventional treatment of the fistula in patients with typical clinical symptoms significantly improved. Single factor analysis to cause hepatic artery portal vein related factors are: tumor type, location and portal vein tumor thrombus, which location of the tumor and portal vein tumor thrombus is the risk factors associated with fistula; 2. Gelatin sponge particles, PVA, ethanol iodized oil embolism move efficacy portal fistula chi-square test showed: PVA,ethanol and lipiodol rims + gelatin sponge particles more effective than gelatin sponge particles(X2 = 30.559, P = 0.001); 3. The fistula recanalization of the single factor analysis shows: Fistula form, fistula thrombus blocking the way(single material or material of solid embolism), location of the tumor and portal vein whether postoperative fistula closure. Multivariate logistic regression analysis showed that single material embolization, the central type of fistula, with the presence of portal vein tumor thrombus in because of the risk factors for liver cancer caused by fistula after operation through the blockage at the cancer embolus and fistula thrombus of.Conclusions: 1. Interventional embolization of the hepatic artery can significantly improve the clinical symptoms of patients;2. By univariate andmultivariate analysis of hepatocellular carcinoma with fistula formation risk factors location of the tumor and portal vein thrombosis;3. PVA, ethanol and lipiodol rims+ gelatin sponge particles more effective than gelatin sponge particles(X2 = 30.559, P= 0.001); 4. multivariate analysis of the risk factors that cause the leakage of the fistula were: single material embolism, central fistula, combined portal vein tumor thrombus;5. In summary, the combined hepatic artery fistula an active rows of liver cancer should arterial embolization; the effective closure of the fistula after a short-term effect is very positive, especially in lowering portal pressure and thus reduce or even eliminate the portal harm caused by high pressure, improve liver artery and portal vein blood perfusion and thus improving liver function has a very important role, while the primary tumor feeding artery super selective embolization embodiment can be achieved to improve the quality of life of patients and prolong survival therapeutic purposes.