Guadagni S, Pizzutilli A, Mancini E, Varrone A, Palumbo G, Amicucci G, Perri S, Deraco M, Fiorentini G
Department of Surgery, University of L'Aquila, Italy.
Eur J Surg Oncol. 2000 Jun;26(4):381-6. doi: 10.1053/ejso.1999.0903.
The aim of the study was to evaluate the importance of duplex/colour Doppler ultrasound in a protocol of hepatic regional chemotherapy, by measuring the blood flow in the hepatic artery, portal vein, hepatic veins, and inferior caval vein of patients with unresectable liver metastases from colorectal carcinoma.
Thirty-nine consecutive subjects were selected for this study, including 21 patients who had unresectable histologically confirmed liver metastases from colorectal carcinoma (Group A), and 18 asymptomatic volunteers as normal controls (Group B). All subjects of Groups A and B were examined using duplex/colour Doppler sonography. After the ultrasound study, all patients of Group A were submitted to the administration of high dose mitomycin C into the hepatic artery, with concomitant detoxication of post-hepatic venous blood.
The mean value of the hepatic artery blood flow was significantly higher (P=0.0009) in liver metastases patients (361 ml/min, SEM=24 ml/min) than in normal controls (245 ml/min, SEM=20 ml/min). Also, the mean Doppler perfusion index was higher in liver metastases patients than in normal controls. For each patient of Group A, the total dose of mitomycin C to be infused was calculated based on the blood flow in the hepatic artery. In this way the concentration of mitomycin C in the hepatic artery was always greater than 3 microg/ml. The duration of detoxication was calculated based on the blood flow in the inferior caval vein. For two patients only, the blood flow was lower than 1000 ml/min, with the necessity to protract the duration of detoxication over 2 hours.
The measurement of the blood flow in hepatic vessels of patients with liver metastases seems to be very important in establishing the total dose of drug which has to be infused in hepatic arterial chemotherapy, and to determine the duration of concomitant detoxication of post-hepatic venous blood.
本研究旨在通过测量结直肠癌不可切除肝转移患者肝动脉、门静脉、肝静脉及下腔静脉的血流，评估双功/彩色多普勒超声在肝区域化疗方案中的重要性。
本研究连续选取了39名受试者，其中包括21名经组织学证实为结直肠癌不可切除肝转移的患者（A组），以及18名无症状志愿者作为正常对照（B组）。A组和B组的所有受试者均接受双功/彩色多普勒超声检查。超声检查后，A组所有患者均接受肝动脉内高剂量丝裂霉素C注射，并同时进行肝后静脉血解毒。
肝转移患者肝动脉血流平均值（361 ml/min，标准误=24 ml/min）显著高于正常对照组（245 ml/min，标准误=20 ml/min）（P=0.0009）。此外，肝转移患者的平均多普勒灌注指数也高于正常对照组。对于A组的每位患者，根据肝动脉血流计算要注入的丝裂霉素C总剂量。通过这种方式，肝动脉中丝裂霉素C的浓度始终大于3μg/ml。根据下腔静脉血流计算解毒持续时间。仅两名患者的血流低于1000 ml/min，需要将解毒持续时间延长至2小时以上。
测量肝转移患者肝血管中的血流对于确定肝动脉化疗中必须注入的药物总剂量以及确定肝后静脉血解毒的持续时间似乎非常重要。
