Ritz J-P, Lehmann K S, Zurbuchen U, Wacker F, Brehm F, Isbert C, Germer C T, Buhr H J, Holmer C
Department of General, Vascular and Thoracic Surgery, Charité - University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Eur J Surg Oncol. 2007 Jun;33(5):608-15. doi: 10.1016/j.ejso.2007.02.028. Epub 2007 Apr 2.
A prerequisite for an oncologically curative application of laser-induced thermotherapy (LITT) of liver metastases is complete tumor destruction. This increased effectiveness was achieved experimentally by combining LITT with interrupted hepatic perfusion. The aim of this study was to evaluate whether an interventional selective arterial microembolization might be as effective as complete blood flow occlusion using an open Pringle's maneuver.
We included patients with unresectable colorectal liver metastases. LITT was performed without interrupted hepatic perfusion (control group) compared to LITT in combination with interrupted perfusion either by embolization of intraarterial degradable starch microspheres (DSM) (percutaneous access) or by complete hepatic inflow occlusion (Pringle's maneuver; open access). Online monitoring was performed using intraoperative ultrasound or MRI. Volumetric techniques were used to assess metastases and postinterventional lesions.
Fifty-six patients with 104 metastases (control group (25), DSM (37), and Pringle (42)) were treated. The preinterventional tumor volumes were significantly smaller than the postinterventional lesion volumes (control group: 9.8 vs. 25.3 cm3; DSM: 9.5 vs. 65.4 cm3; Pringle: 12.9 vs. 76.5 cm3). The morbidity rate was 21.4% without treatment-related mortalities. After 6 months follow-up, tumor recurrence was diagnosed in 6 patients (control group (4), LITT with DSM (1), and Pringle (1)).
Combining LITT with blood flow occlusion leads to a significant increase in lesion size. The application of DSM offers a safe and effective alternative to the open access with Pringle's maneuver. Compared to LITT-monotherapy, this modality achieves significantly larger thermal lesions with the need of fewer applications.
对肝转移瘤进行激光诱导热疗（LITT）以实现肿瘤根治的一个前提条件是完全破坏肿瘤。通过将LITT与间歇性肝灌注相结合，在实验中提高了这种治疗的有效性。本研究的目的是评估介入性选择性动脉微栓塞是否与使用开放的普林格尔手法完全阻断血流一样有效。
我们纳入了不可切除的结直肠癌肝转移患者。与通过动脉内注射可降解淀粉微球（DSM）栓塞（经皮途径）或完全肝血流阻断（普林格尔手法；开放途径）进行间歇性灌注的LITT相比，一组LITT未进行间歇性肝灌注（对照组）。使用术中超声或磁共振成像进行在线监测。采用容积技术评估转移瘤和介入后病变。
56例患者共104个转移瘤接受了治疗（对照组25个、DSM组37个、普林格尔组42个）。介入前肿瘤体积显著小于介入后病变体积（对照组：9.8 vs. 25.3 cm³；DSM组：9.5 vs. 65.4 cm³；普林格尔组：12.9 vs. 76.5 cm³）。发病率为21.4%，无治疗相关死亡。随访6个月后，6例患者被诊断为肿瘤复发（对照组4例、LITT联合DSM组1例、普林格尔组1例）。
将LITT与血流阻断相结合可显著增加病变大小。DSM的应用为开放的普林格尔手法提供了一种安全有效的替代方法。与LITT单一疗法相比，这种方式能产生显著更大的热损伤，且所需治疗次数更少。
