几种栓塞材料的肝动脉栓塞临床应用

作者从1988年9月至1991年6月对141例肝脏肿瘤进行了肝动脉及相关血管的栓塞治疗。其中原发性肝癌99例,肝转移瘤38例,肝脏海绵状血管瘤4例。作者采用了明胶海绵、碘化油、碘苯酯、聚乙烯醇微球、Angiostat和不锈钢圈等栓塞材料进行肝动脉栓塞治疗。作者评价了上述栓塞材料的临床应用方法和结果。作者体会到,不同栓塞材料和栓塞方法各有优缺点,应根据病情、肿瘤大小、肿瘤血管和肿瘤染色,是否合并肝动静脉瘘,有无门静脉瘤栓形成,插管技术、材料来源等情况综合考虑,合理使用、正确选择。     

经动脉栓塞治疗巨大肝血管瘤效果分析

目的评价经动脉栓塞治疗巨大肝血管瘤的疗效。方法53例患者共行78次动脉内栓塞治疗，所用栓塞剂为平阳霉素 超液化碘化油乳剂。结果每次治疗后4～6周CT复查，所有病灶均有不同程度缩小，其中21例缩小达50％。结论经肝动脉栓塞治疗巨大血管瘤是一种行之有效的方法。     

原发性肝癌动脉栓塞治疗预后因素分析

原发性肝癌动脉栓塞治疗预后因素分析王天才刘南植王南下田德安梁扩寰肝动脉栓塞（ＴｒａｎｓｃａｔｈｅｔｅｒＡｒｔｅｒｌａｌＥｍｂｏｌｚａ作者单位：同济医科大学同济医院（４３００３０武汉汉口解放大道５１５号）ｔｌｏｎ．ＴＡＥ）是８０年代发展起来的一种治疗中...     

开腹肝动脉栓塞化疗治疗中,晚期肝癌

本文报告39例肝肿瘤(37例为原发肝癌)使用开腹肝动脉栓塞方法治疗的体会。栓塞材料为:明胶海绵、TH胶、微球、碘油等。疗效:疼痛好转14例,体重增加12例,肿瘤缩小21例,疗效不明显10例,死亡2例。1例TH胶栓塞后4个月行二期切除成功,现术后生存11个月无复发征。1例肝右叶巨大肿瘤TH胶栓塞后缩小,达4年仍生存。体会:开腹肝动脉栓塞法,病理诊断明确,判断切除可能性确切,插管准确,发生异位栓塞机会少。     

特制瓷粉应用于肝血管栓塞在动物实验中的初步观察

本实验采用特制瓷粉对健康的大白鼠，成年杂种狗进行肝血管栓塞，体内毒性实验研究。结果表明该栓塞材料无毒性反应，不被吸收；性能持久稳定，栓塞作用完全彻底，比现有的血管栓塞材料有其独特的优点。     

超常规剂量碘油超选择栓塞肝动脉治疗原发性肝癌

目的：探讨应用超常规剂量碘油超选择栓塞肝动脉治疗原发性肝癌的疗效。方法：1987年8月-1999年12月12年间167例原发性肝癌,应用常规导管或球囊导管超选择至肿瘤供血动脉,阴断其血流,使注射碘油时不产生逆流。将全部动脉肿瘤血管、病变周围正常的小动脉及肝实质和门静脉分支栓塞。结果：栓塞全部动脉肿瘤血管、病变周围正常的小动脉及肝实质167例,门静脉分支栓塞109例。1、2、3、4、5年生存率分别为98.8%(165/167)、79.9%(107/134)、48.0%(47/98)、36.6%(26/71)、25.5%(12/47)。没有严重并发症发生。结论：应用超常规剂量碘油超选择栓塞肝动脉治疗原发性肝癌效果良好,安全。     

肝动脉化疗栓塞术治疗肝癌破裂出血

自发性破裂出血是肝癌严重的并发症之一，因出血和肿瘤双重因素影响致使临床处理较为困难。以往多行急诊肝切除治疗，但存在着较高的病死率。我们于2001年7月～2003年12月对16例肝癌破裂出血患者采用急诊介入栓塞止血方法取得满意疗效。结果报道如下。     

原发性肝癌经肝动脉化疗栓塞性存三年以上20例临床分析

原发性肝癌经肝动脉化疗栓塞１１０例，存活３年以上者２０例，占ＴＡＥ治疗的１８．２％；存活４年者７例，占６．３％，＞５年者４例，占３．６％。对失去手术机会的中晚期肝癌，ＴＡＥ为首选姑息疗法，提高疗效，延长生存期的重要因素是：患者基础肝功能良好；单一巨块型，直径＜１０ｃｍ；合理安排栓塞间隔期；及时处理并发症和积极治疗肝内外转移灶。     

不能切除的肝癌术中治疗模式的探讨

自１９６４年４月－１９９３年７月对２００例不能切除的肝癌术中多种模式治疗。患者均经手术及病理证实。按治疗方法分为两组。１组：１１５例单纯作肝动脉插管化疗（ＨＡＩ），其１、２年生存率分别为１０．４％和１．７％，仅１例生存６５个月；Ⅱ组：８６例术中作肝动脉栓塞化疗（ＨＡＣＥ）和加用肝动脉结扎（ＨＡＬ）或伴有波刀肿瘤固化（ＭＩＣ）、或伴有纯酒精肿瘤内注射（ＥＩＴ）的多模式治疗，其中１、２、３和５年生存率     

Assessment of future remnant liver regeneration after portal vein embolization using three‐dimensional CT and MR volumetric analyses

The purpose of this study is to portray right portal vein embolization (PVE) as a valuable technique that helps in expanding the volume of the left liver lobe and discuss the relevant published work. We describe our experience with four patients who underwent PVE and analyse the value of CT and MRI in the preoperative evaluation of these patients. Four patients with hepatic malignancy (hepatocellular carcinoma) (n = 2) and metastatic liver disease (n = 2) underwent portal vein occlusion. PVE was carried out in three patients using polyvinyl alcohol and stainless steel coils. Portal vein ligation was carried out in the fourth patient. In patients who were candidates for right hepatectomy, CT volumetric analysis was carried out before the surgery to assess the total liver volume and the future remnant liver, which is the residual left hepatic volume (in cases of right hepatectomy) or left lateral segment volume (in cases of right tri‐segmentectomy). Because the left lobe volumes were insufficient, patients were selected to undergo right PVE. Computed tomography volumetry was carried out 2–4 weeks after embolization to assess left hepatic lobe regeneration. Magnetic resonance volumetric analysis was carried out in two patients before and after embolization. All four patients had significant regeneration of the left lobe and tolerated the surgery with uneventful postoperative recovery.     

Conversion of surgically verified unresectable to resectable hepatocellular carcinoma

During the period 1978–1987, 255 patients with pathologically proven hepatocellular carcinoma (HCC) were determined by laparotomy to be unresectable, 155 (60.8%) out of them had their tumor mainly confined in right or left lobe and considered to be potentially resectable if remarkable tumor shrinkage appears after treatment. Second look operation was performed in 26 (16.8%) out of the 155 patients after marked reduction of tumor size, resection was done in all of these 26 patients. Triple or quadruple combination treatment with hepatic artery ligation (HAL), hepatic artery infusion (HAI) with chemotherapy, radiotherapy using linear accelerator, and radioimmunotherapy using 131-I antihuman HCC ferritin antibody yielded the highest conversion rate (29.8%, 14/47) as compared to double combination treatment with HAL+HAI, or cryosurgery+HAL (16.9%, 12/71) and single treatment with HAL or HAI or HAE (embolization) (0%, 0/37). The median tumor size of these 26 patients was reduced from 9.5 cm to 5.0 cm after combination treatment. The median interval between the first laparotomy and the subsequent resection was 5.0 (2–16) months. The survival rates calculated by life table method were: 1-year 86.5%, 2-year 74.3% and 3-year 74.3%. Nine cases have survival more than 3 years. Thus, multimodality combination treatment with subsequent resection might prolong survival significantly for some patients with unresectable HCC particularly confined in right lobe of a cirrhotic liver.     

经导管肝动脉和B超引导下经细针门静脉双重化疗栓塞治疗原发性肝癌

目的　研究经导管肝动脉化疗栓塞 (TACE)联合B超引导下经细针门静脉化疗栓塞(PVE)治疗原发性肝癌的疗效。方法　原发性肝癌 2 0 9例 ,其中TACE 10 4例 ,TACE +PVE 10 5例。结果　TACE组和TACE +PVE组总有效率 (CR +PR)分别为 37.5 %和 5 7.2 % ,差异有显著性 (P <0 .0 1)。门静脉癌栓消失 +缩小率分别为 2 2 .2 %和 6 8.8% ,差异有显著性 (P <0 .0 1)。 1,2 ,3年生存率TACE组分别为 6 5 .1%、36 .3%和 2 0 .5 % ;TACE +PVE组分别为 95 .6 %、5 9.6 %和 39.1% ,两组差异有显著性 (P <0 .0 5 )。结论　经导管肝动脉和B超引导下经细针门静脉双重化疗栓塞治疗原发性肝癌疗效优于单纯TACE。B超引导下经细针PVE操作简便 ,并发症少 ,值得临床推广使用。     

A successful case of more than 5 years of disease free survival in hepatocellular carcinoma with tumor thrombus to the right main branch of portal vein after repeated hepatic resection following transhepatic arterial embolization (TAE)

A case is a male in his 50's. He received hepatic resections twice for hepatocellular carcinoma. Recurrence was pointed out in the residual liver with tumor thrombus to the right branch of the portal vein. The serum level of AFP was 648 ng/ml. We performed transhepatic arterial embolization (TAE) with Epi-ADM, CDDP, Lipiodol and spongel through the right hepatic artery before re-hepatectomy. Posterior segmentectomy with an extraction of portal vein thrombus was performed. Pathological findings showed complete necrosis not only in the main tumor but in the portal vein thrombus also. He is alive for more than 5 years without recurrence after surgeries following pre-operative TAE.     

A patient with hepatocellular carcinoma and portal vein thrombosis in 1st branch who was treated by transcatheter arterial embolization]

We report a patient with hepatocellular carcinoma (HCC) with portal vein thrombosis in the 1st branch who was treated by transcatheter arterial embolization (TAE) and survived more than 3 years. A 58-year old male was diagnosed as having unresectable massive type HCC in the area of S8 with portal vein thrombosis from the P8 branch to the right portal branch. He was treated by TAE via the anterior branch of right hepatic artery. One week later, localized hepatic infarction in the anterior segment was recognized. Five months later, the portal vein thrombosis had disappeared and become necrotic. After 3 years and 4 months, he died of a relapse of a gastric varix, but with no portal thrombosis and a well controlled intra-hepatic recurrence that was treated by repeated TAE. This case suggests that TAE might be effective for cases of HCC with portal vein thrombosis in the 1st branch, if the liver function and portal flow are suitable.     

原发性肝癌患者手术前后入肝血流量的观察

作者用Ｂ超多普勒复合装置测定了６２例肝癌患者手术前后的入肝血流量。结果：①无门脉主干癌栓的肝癌患者术前肝固有动脉血流量和门静脉血流量均大于对照组；②肝固有动脉结扎加栓塞术后，门静脉血流量增加；③右半肝切除术后肝固有动脉血流量的减少较肝右动脉结扎加栓塞术后更为明显；④门静脉主干癌栓经治疗（肝动脉和门静脉灌注化疗）缩小后，门静脉血流量增加，肝固有动脉血流量减少；⑤门静脉血流增加的量与肝固有动脉血流量减     

Trans-ileocecal portal vein embolization as a preoperative treatment for right trisegmentectomy with caudate lobectomy

BACKGROUND AND OBJECTIVES: The indication of preoperative portal vein embolization (PVE) has been expanded to hepatocellular carcinoma, cholangiocellular carcinoma (CCC), hepatic metastasis, and gallbladder (GB) cancer as well as hilar cholangiocarcinoma (hCC). However, biliary cancers sometimes cause peritoneal dissemination. PATIENTS AND METHODS: We performed our preoperative trans-ileocecal-vein PVE (TIPE) method on 14 (3 GB cancer, 1 CCC, and 10 hCC), whose estimated residual liver volume was <30%. RESULTS: Out of 14 patients, peritoneal dissemination was encountered in two patients with GB cancer and one with hCC (21.4%) during our procedure. The estimated residual liver volume was 37.4 +/- 2.7% at 14 days after PVE in patients without predisposing cholangitis, while those in patients with cholangitis was 29.3 +/- 1.3% (P = 0.0002). No major complication due to the procedure was encountered in this series. CONCLUSIONS: PTPE could be the first choice for patients with hCC, hepatocellular carcinoma, and hepatic metastases. Although the TIPE proposed here has some potential disadvantages, we would recommend it especially for patients with GB cancer because of its high potential to cause cancerous peritonitis. When a patient had predisposing cholangitis, radical operation should be scheduled on >21 days after PVE rather than on 14 days.     

Pre-hepatectomy portal vein embolization: Single center experience

Aim

To evaluate the feasibility and the effectiveness of portal vein embolization (PVE) as preoperative treatment in patients scheduled to undergo right hepatectomy, when the volume of the future remnant liver (FRL) appears to be insufficient to prevent the risk of post-surgical hepatic failure.

Materials and Methods

Thirty-one consecutive patients (19 men, 12 women; age range: 54–77 years; mean age: 66.2 years) with liver malignancy (7 hepatocellular carcinoma, 13 metastases, 9 cholangiocarcinoma, and 2 gallbladder carcinoma) were selected after clinical–radiological evaluation for PVE. After the embolization changes in volume of FRL, portal pressure, liver enzymes, and complications before and after hepatectomy were assessed.

Results

PVE was successful in all patients without major complications. The mean volume of FRL, calculated before and 4 weeks after PVE, increased from 319.2 ± 45.1 to 460.2 ± 27.7 cm³ (+44.2%) in the non-cirrhotic group and from 458.4 ± 38.3 to 605.2 ± 27 cm³ (+32.1%) in the cirrhotic group. The FRL/TELV ratio increased by 9%.

Conclusion

In our experience, PVE resulted feasible, safe, with a very low rate of complications, and effective to induce liver regeneration before right hepatectomy in patients with liver malignancy.     

X-ray endovascular embolization of the hepatic artery in the palliative treatment of hepatocellular cancer

X-ray endovascular embolization of hepatic artery (HAE) was carried out in 10 cases of liver cell carcinoma (hepatic cirrhosis included). Immediate beneficial effect was recorded in 8 cases. Remission for 12 months and more was registered in three cirrhosis-free patients; mean survival in five patients was 15 months. In cases of cancer aggravated with cirrhosis, HAE effectiveness proved much lower and survival dropped to average 5.5 months.     

Effect of hepatic artery ligation on the incorporation of 3H-orotic acid into an adenocarcinoma transplanted to rat liver

In the model of secondary liver cancer in Wistar rats a study was made of the influence of hepatic artery ligation (HAL) on the amount of nucleotides and RNA in tumor and liver tissue and on the uptake of 3H-orotic acid into these compounds and DNA after labelling for 90 minutes. Ten days after inoculation with tumor cells into the central liver lobe, a catheter was placed into the portal vein in all rats and in half of them the hepatic artery was ligated. On days one, three, five or ten, rats were given 3H-orotic acid through the catheter. On day ten 3H-orotic acid was also infused via the femoral vein or intraperitoneally. After HAL there was a decrease in the nucleotide and RNA content of the tumor cells after one, three and five days. There was no such decrease in the liver cells. In all HAL rats there was an increase in the nucleotide and RNA content of the tumor cells at day ten compared to day five. The ratio of RNA to acid soluble fraction labelling in tumors was also increased on day ten in all groups compared to HAL rats at day five. The increased uptake of 3H-orotic acid into tumour RNA at day ten after HAL strongly suggests rearterialization. There was no support for an increased vascularization of the tumor from the portal vein on day three or five. In the liver tissue, HAL had no influence. This experimental study gives no support for the use of hepatic dearterialization followed by intraportal infusion av cytostatic agents in clinical settings.