Shimamura Y, Shimizu H, Takenaka Y, Akimoto H, Shima Y, Arima K, Takahashi A, Kitaya T, Matsuyama T, Hasegawa H
Gan To Kagaku Ryoho. 1986 Apr;13(4 Pt 2):1596-602.
Two hundred sixty-six cases of hepatocellular carcinoma (HCC) were treated between June 1980 and October 1985 (4 years and 4 months) at our hospital. Hepatectomy was performed in 118 patients, 82 of which had received transcatheter arterial embolization with iodized oil (Lipiodol) 58 of then with an intraarterial catheter. HCC tumors were often multiple when they were combined with liver cirrhosis and smaller than 3 cm in diameter. For this reason treatment of HCC by surgery alone has limitations for prolongation of life. A multidisciplinary treatment is therefore necessary. We have found hepatectomy and transarterial embolization to be the most effective treatment for HCC. In order to perform repeated embolizations after hepatectomy, we developed a heparinized catheter with notches to permit safe fixation. This is suitable for long-term intraarterial use. While previous arterial catheters only permitted infusion of drugs due to their small diameters, our new catheter can be used for embolizations with Lipiodol and Gelfoam and for angiography. It is inserted through the right gastroepiploic artery into the gastroduodenal artery so that its tip lies at the level of the hepatic artery. It is brought out through the abdominal skin and flushed at two-week intervals with heparin-urokinase. The indications for the use of the catheter have been repeated embolizations 1) for prevention of tumor recurrence (surgical adjuvant therapy), and 2) after absolutely non-curative operations. For the first indication, we have found that multiple tumors and tumors larger than 5 cm frequently recur within 1 year after surgery. We have, since July 1983, used the catheter treatment to prevent recurrence in 30 such cases. Embolization with Lipiodol + Adriamycin followed by Gelfoam cubes is performed at three-month intervals for one year after surgery, starting one month after surgery, as a rule. The preliminary results indicate an improved survival rate after the treatment.
1980年6月至1985年10月（4年4个月）期间，我院共治疗了266例肝细胞癌（HCC）患者。118例行肝切除术，其中82例接受了碘化油（Lipiodol）经导管动脉栓塞术，58例使用动脉内导管。HCC肿瘤合并肝硬化时多为多发，直径小于3 cm。因此，单纯手术治疗HCC延长生命有局限性。因此，多学科治疗是必要的。我们发现肝切除术和经动脉栓塞术是治疗HCC最有效的方法。为了在肝切除术后进行重复栓塞，我们研制了一种带缺口的肝素化导管，以确保安全固定。这种导管适合长期动脉内使用。以往的动脉导管由于直径小只能用于药物输注，而我们的新导管可用于Lipiodol和明胶海绵栓塞及血管造影。它通过右胃网膜动脉插入胃十二指肠动脉，使其尖端位于肝动脉水平。导管经腹部皮肤引出，每两周用肝素 - 尿激酶冲洗一次。该导管的使用指征为重复栓塞：1）预防肿瘤复发（手术辅助治疗）；2）在绝对无法治愈的手术后。对于第一个指征，我们发现多发肿瘤和直径大于5 cm的肿瘤在术后1年内常复发。自1983年7月以来，我们已使用导管治疗预防30例此类病例的复发。通常在术后1个月开始，术后1年内每隔3个月进行一次Lipiodol + 阿霉素栓塞，随后用明胶海绵方块栓塞。初步结果表明治疗后生存率有所提高。
