Mack P, Jeppsson B, Widlus D, Hägerstrand I, Bengmark S
Department of Surgery, Lund University, Sweden.
Eur J Cancer Clin Oncol. 1988 May;24(5):909-13. doi: 10.1016/0277-5379(88)90201-5.
Arterial occlusive therapy in the palliation of liver cancers has gone a long way since the first attempt at hepatic artery ligation. While efforts in permanent hepatic dearterialization have been frustrating in the face of fast developing collaterals, temporary inhibition of hepatic arterial blood flow appears to offer definite advantages. The effect of a single transient hepatic arterial occlusion with and without the addition of intraperitoneal 5FU was tested in Wistar-Furth rats bearing liver tumours. No advantage was observed in terms of tumour growth inhibition unless toxic doses of 5FU were used. A 5-day course of repeated treatment using intermittent dearterialization combined with intraperitoneal 5FU infusion was next tested and was found to be an efficient approach in reducing tumour growth rates. We prefer the intraperitoneal rather than the intraportal route for the infusion of oncolytic drugs because it avoids the problem of portal thrombosis and at the same time deals with any concomitant extrahepatic disease.
自首次尝试肝动脉结扎以来,动脉闭塞疗法在肝癌姑息治疗方面已经取得了长足的进展。尽管在面对快速形成的侧支循环时,永久性肝去动脉化的努力令人沮丧,但暂时抑制肝动脉血流似乎具有明显优势。在携带肝肿瘤的Wistar-Furth大鼠中测试了单次短暂性肝动脉闭塞(无论是否添加腹腔内5-氟尿嘧啶)的效果。除非使用有毒剂量的5-氟尿嘧啶,否则在肿瘤生长抑制方面未观察到优势。接下来测试了使用间歇性去动脉化联合腹腔内5-氟尿嘧啶输注的为期5天的重复治疗疗程,发现这是一种降低肿瘤生长速率的有效方法。我们更倾向于通过腹腔内而非门静脉内途径输注溶瘤药物,因为这样可以避免门静脉血栓形成的问题,同时还能处理任何伴随的肝外疾病。