McDermott W V, Hensle T W
Ann Surg. 1974 Sep;180(3):305-8. doi: 10.1097/00000658-197409000-00008.
A historical review of work bearing on the rationale for hepatic artery ligation in the treatment of malignant disease in the liver is presented, particularly the early work showing that malignant disease of the liver is supplied primarily by the arterial circulation and not by the portal. A review is presented of some clinical reports dealing with the effectiveness of this approach and our own limited experience with three cases presented briefly. The major emphasis is placed on the metabolic, arteriographic, microscopic and clinical studies on one patient with the carcinoid syndrome who was followed carefully over several years, treated initially by hepatic resection, later by chemotherapy and finally by hepatic dearterialization as the tumor re-grew and the carcinoid syndrome again became incapacitating. Clinical remissions was documented by changes in the excretion of 5-hydroxyindole- acetic acid and by comparison between pre- and post-op arteriography and by microscopic sections taken at re-exploration for drainage of a necrotic area in the liver.
本文对有关肝动脉结扎治疗肝脏恶性疾病理论依据的相关工作进行了历史回顾，尤其关注早期研究，这些研究表明肝脏恶性疾病主要由动脉循环供血，而非门静脉。本文还回顾了一些关于该方法有效性的临床报告，以及我们自身对三例病例的有限经验，并做了简要介绍。重点介绍了对一名患有类癌综合征患者进行的代谢、动脉造影、显微镜检查及临床研究，该患者在数年中接受了仔细随访，最初接受肝切除术，之后进行化疗，最终在肿瘤复发且类癌综合征再次导致功能丧失时接受了肝去动脉化治疗。通过5-羟吲哚乙酸排泄量的变化、术前与术后动脉造影的对比以及为引流肝脏坏死区域而再次手术时所取的显微镜切片，记录了临床缓解情况。
