Elias D, Lasser P, Rougier P
Department of Digestive Oncologic Surgery, Institut Gustave-Roussy, Villejuif, France.
Eur J Surg Oncol. 1987 Oct;13(5):441-8.
The purpose of this study was to prove that only one intra-arterial catheter for hepatic chemotherapy can perfuse the whole liver in all anatomic cases, including cases with aberrant or accessory hepatic arteries. The ligations of various hepatic arteries induce the immediate aperture of intra hepatic arterial shunts and a total revascularization of the whole liver by the only remaining hepatic artery. Based on the experience from 50 consecutive cases of surgical implantation of intra-arterial catheters for local chemotherapy, the simplified technique is analysed principally as a function of anatomical variations of the hepatic artery. The usual procedure (catheter implanted into the gastro-duodenal artery) was performed in 58% of the cases, while in 28% of the cases this was possible only after section of a right and/or a left aberrant or accessory hepatic artery. Unusual implantations were necessary in 14% of the cases to ensure complete perfusion of liver. The evaluation was based on three criteria: intra-operative perfusion of fluorescein, post-operative scan with 99mTc macro-aggregated albumin and objective clinical responses after intra-arterial chemotherapy. The perfusion of the whole liver was good in all cases except one. Unusual procedures gave the same clinical objective responses after intra-arterial chemotherapy (61%) as usual procedures (48%) (chi-square: P = 0.40).
本研究的目的是证明，对于包括存在肝动脉变异或副肝动脉的所有解剖情况，仅一根用于肝化疗的动脉内导管即可灌注整个肝脏。各种肝动脉的结扎会导致肝内动脉分流立即开放，并且仅通过剩余的肝动脉实现整个肝脏的完全再血管化。基于连续50例动脉内导管手术植入进行局部化疗的经验，主要根据肝动脉的解剖变异情况对简化技术进行分析。58%的病例采用常规方法（将导管植入胃十二指肠动脉），而28%的病例仅在切断一条右侧和/或左侧变异或副肝动脉后才得以实现。14%的病例需要采用非常规植入方法以确保肝脏完全灌注。评估基于三个标准：术中荧光素灌注、术后用99mTc大颗粒聚合白蛋白扫描以及动脉内化疗后的客观临床反应。除1例病例外，所有病例的全肝灌注均良好。非常规方法在动脉内化疗后产生的临床客观反应（61%）与常规方法（48%）相同（卡方检验：P = 0.40）。
