Ben-Shabat Ilan, Hansson Christoffer, Sternby Eilard Malin, Cahlin Christian, Rizell Magnus, Lindnér Per, Mattsson Jan, Olofsson Bagge Roger
Department of Surgery, Institute of Clinical Sciences; Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg.
Department of Thoracic Surgery, Institute of Clinical Sciences; Sahlgrenska University Hospital, Sahlgrenska Academy at the University of Gothenburg.
J Vis Exp. 2015 Jan 25(95):52490. doi: 10.3791/52490.
Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra- and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation. In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.
孤立肝灌注（IHP）是一种手术操作，即通过手术将肝脏分离出来，并用高浓度的化疗药物美法仑进行灌注。简要来说，该操作首先要建立从股静脉到颈外静脉的经皮静脉-静脉旁路。然后通过剖腹术，将导管插入肝固有动脉和腔静脉。接着，在肝上下方分别夹闭门静脉和腔静脉。将动脉和静脉导管连接到心肺机上，用美法仑（1毫克/千克体重）对肝脏进行60分钟的灌注。通过这种方式，可以在不渗漏到体循环的情况下，对肝脏进行高剂量化疗药物的局部灌注。在先前包括患有葡萄膜黑色素瘤孤立肝转移患者的研究中，报告的总体缓解率为33%-100%，中位生存期为9至13个月。本方案的目的是清晰描述如何进行该操作，并讨论IHP作为葡萄膜黑色素瘤肝转移的一种治疗选择。
