Popa Bogdan, Popiel Monica, Gulie Laurenţiu, Turculeţ Claudiu, Beuran Mircea
Clinical Emergency Hospital Bucharest, Calea Floreasca 8, Sector 1, Bucharest, Romania.
J Med Life. 2008 Oct-Dec;1(4):383-9.
First transcatheter embolization of hepatic artery has been materializing in 1974, in France, for unresectable hepatic tumours. Then, this treatment has become use enough in many countries, especially in Japan, where primary hepatic tumours are very frequent. In this article, we present procedures of interventional endovascular treatment for primary hepatic tumours: chemoembolization, intra-arterial chemotherapy. The study comprises patients with primary hepatic tumours investigated by hepatic-ultrasound and contrast-enhanced CT or MRI. DSA-hepatic angiography is very important to verify the accessory hepatic supply. It has been performed selective catheterization of right/left hepatic branches followed by cytostatics injection. Most of the patients have benefit by hepatic chemoembolization (cytostatics, Lipiodol and embolic materials). The selective intra-arterial chemotherapy (cytostatics without Lipiodol) was performing in cases with contraindications for Lipiodol or embolic materials injection (cirrhosis-Child C, thrombosis of portal vein, hepatic insufficiency). For treatment of primary hepatic tumours we use 5-F-Uracil, Farmarubicin and Mytomicin C. Less numbers of the reservoirs were placed because financial causes. Chemoembolization was better than procedures without Lipiodol or embolic materials. Lipiodol reached in tumoural tissue and the distribution of Lipiodol harmonises with degree of vascularisation. After the chemoembolization procedure, the diameter of tumours decreased gradually depending on the size of tumour. Effective alternative for unresectable primary hepatic tumours (big size, hepatic dysfunction, and other surgical risk factors) is endovascular interventional treatment.
1974年，在法国首次实现了经导管肝动脉栓塞术用于不可切除的肝肿瘤治疗。此后，这种治疗方法在许多国家得到了广泛应用，尤其是在原发性肝肿瘤非常常见的日本。在本文中，我们介绍了原发性肝肿瘤的介入性血管内治疗方法：化疗栓塞术和动脉内化疗。该研究纳入了通过肝脏超声、增强CT或MRI检查的原发性肝肿瘤患者。DSA肝脏血管造影对于确认肝脏的副供血非常重要。我们对肝右/左分支进行了选择性插管，随后注入细胞毒性药物。大多数患者受益于肝化疗栓塞术（细胞毒性药物、碘油和栓塞材料）。对于碘油或栓塞材料注射有禁忌证（Child C级肝硬化、门静脉血栓形成、肝功能不全）的病例，采用选择性动脉内化疗（不使用碘油的细胞毒性药物）。对于原发性肝肿瘤的治疗，我们使用5-氟尿嘧啶、表柔比星和丝裂霉素C。由于经济原因，放置的储液器数量较少。化疗栓塞术优于不使用碘油或栓塞材料的治疗方法。碘油进入肿瘤组织，其分布与血管化程度相协调。化疗栓塞术后，肿瘤直径根据肿瘤大小逐渐减小。对于不可切除的原发性肝肿瘤（体积大、肝功能障碍和其他手术风险因素），血管内介入治疗是一种有效的替代方法。
