Gunvén Peter
Department of Oncology, Radiumhemmet, Karolinska University Hospital at Solna, Stockholm 171 76, Sweden.
Med Oncol. 2007;24(3):287-96. doi: 10.1007/s12032-007-0040-x.
Arterial embolization of the liver may temporarily retard the growth of its primary and secondary tumors which are both mainly nourished arterially. Addition of radioisotopes, mostly (131)I or (90)Y, results in radioembolizations which predominantly act by radiation and less by ischemia. They may therefore be utilized in the absence of portal venous flow when conventional embolization is hazardous. (131)I-oily radioembolization seems to prolong short-term survival in such patients with unresectable hepatocellular cancers, and to improve the prognosis after resection of hepatocellular cancer. The procedure does however not palliate better than "cold" chemoembolization in patients with preserved portal flow, except for having milder side effects. Embolization with (90)Y-coupled microspheres may shrink primary and secondary liver tumors but has so far unproven effects on survival. Embolization of portal venous branches gives compensatory hypertrophy of the non-embolized liver and can increase the volume of the future remnant liver before resection. This diminishes the risk for postoperative liver failure after extensive resection and/or in the presence of chronic liver disease, and permits wider surgical indications. Tumor growth may however be accelerated, and the hypertrophy is inhibited by severe liver parenchymal disease in which situation the method would be most needed. Experimental use of liver arterial embolizations includes combined arterial and portal embolizations, i.e. "chemical hepatectomy," arterial embolizations before external radiotherapy, administration of boron for neutron capture therapy, immunoembolizations, and future gene therapy.
肝脏动脉栓塞术可暂时延缓其原发性和继发性肿瘤的生长，这些肿瘤主要由动脉供血。添加放射性同位素，主要是（131）I或（90）Y，可导致放射性栓塞，其主要通过辐射起作用，缺血作用较小。因此，当传统栓塞术有风险时，在门静脉血流缺失的情况下可使用放射性栓塞术。（131）I油性放射性栓塞术似乎可延长此类无法切除的肝细胞癌患者的短期生存期，并改善肝细胞癌切除术后的预后。然而，在门静脉血流保留的患者中，该手术的缓解效果并不比“冷”化疗栓塞术更好，只是副作用较轻。用（90）Y偶联微球进行栓塞可使原发性和继发性肝肿瘤缩小，但迄今为止对生存期的影响尚未得到证实。门静脉分支栓塞可使未栓塞的肝脏发生代偿性肥大，并可在切除术前增加未来剩余肝脏的体积。这可降低广泛切除术后和/或存在慢性肝病时发生术后肝衰竭的风险，并允许更广泛的手术指征。然而，肿瘤生长可能会加速，而严重的肝实质疾病会抑制肥大，而在这种情况下该方法是最需要的。肝脏动脉栓塞术的实验应用包括动脉和门静脉联合栓塞，即“化学肝切除术”、外照射放疗前的动脉栓塞、用于中子俘获治疗的硼给药、免疫栓塞以及未来的基因治疗。
