Civalleri D, Scopinaro G, Simoni G, Claudiani F, Repetto M, De Cian F
Tumori. 1985 Aug 31;71(4):375-7. doi: 10.1177/030089168507100410.
A basic requirement for arterial chemotherapy of liver tumors is complete catheter perfusion of the liver. In cases with atypical anatomy of the hepatic artery, it is frequently impossible to obtain this goal by means of a single catheter. In a patient with a right replaced hepatic artery, the aberrant vessel was ligated and the left hepatic artery was perfused through a catheter inserted into the gastroduodenal artery. Perfusion scans performed through the catheter 14 and 135 days after arterial ligation showed a fall in the arterial flow to the right liver (right/left ratio 0.43 and 0.60). In contrast, a nearly complete perfusion of the liver (0.91 right/left ratio) was obtained 28 days after ligation, when the perfusion scan was performed immediately after catheter infusion of 90,000,000 degradable starch microspheres (DSM: diameter = 40 m). DSM administration is supposed to increase back pressure in the lobe receiving native circulation, thus activating intrahepatic collateral flow to the ischemic lobe. As regards regional treatment of liver tumors, obvious conclusions are to be drawn.
肝肿瘤动脉化疗的一项基本要求是对肝脏进行完全的导管灌注。在肝动脉解剖结构不典型的病例中，常常无法通过单一导管实现这一目标。在一名右肝动脉替代的患者中，异常血管被结扎，通过插入胃十二指肠动脉的导管对左肝动脉进行灌注。动脉结扎后14天和135天通过导管进行的灌注扫描显示右肝动脉血流下降（右/左比率分别为0.43和0.60）。相比之下，结扎后28天，在向导管内注入9000万个可降解淀粉微球（DSM：直径 = 40μm）后立即进行灌注扫描时，获得了几乎完全的肝脏灌注（右/左比率为0.91）。DSM给药被认为会增加接受正常循环的肝叶中的背压，从而激活向缺血肝叶的肝内侧支血流。关于肝肿瘤的区域治疗，可以得出明显的结论。
