Nishizaki T, Takenaka K, Yoshida K, Ikeda T, Sugimachi K
Department of Surgery, Fukuoka City Hospital, Japan.
J Surg Oncol. 1995 Apr;58(4):263-8. doi: 10.1002/jso.2930580413.
Lipiodolization--selective regional cancer chemotherapy using Lipiodol plus an anticancer drug (LPD)--can prolong survival time of patients with an unresectable hepatocellular carcinoma (HCC). To enhance understanding of LPD's influence on the cirrhotic liver, we carried out related studies. Forty-three cirrhotic patients with HCC were treated with LPD (epirubicin in a dose of 15-40 mg/m2 and Lipiodol of 0.02-0.25 ml/kg). Seven cirrhotic patients with HCC were subjected to hepatic angiography alone, and these subjects selected randomly served as controls. Among the 43 treated with LPD, 23 belonged to Child's class A, 15 to class B, and 5 to class C. Blood samples were taken before angiography (pre) and at 24 hours after angiography (post) from each patient. Post/pre ratio of the following parameters were compared between patients of the two groups: sGOT, sGPT, and LDH as a marker for hepatocyte injury; t. bilirubin and hepaplastin test (HPT) as hepatocyte function; alkaline phosphatase and gamma-GTP to examine bile duct injury; and serum hyaluronic acid level to determine an endothelial cell functions. Post/pre ratio of serum GOT, GPT, LDH levels, and HPT in patients treated with vs. without LPD were 1.32 +/- 0.59 vs. 0.92 +/- 0.09 (P < 0.001), 1.18 +/- 0.43 vs. 0.88 +/- 0.09 (P < 0.001), 1.11 +/- 0.20 vs. 1.00 +/- 0.07 (P < 0.05), and 0.95 +/- 0.10 vs. 1.09 +/- 0.12 (P < 0.01), respectively. There were no significant differences in post/pre LPD ratio of other parameters, rates of complications, and hospital stay after LPD for patients with Child's class A, B, and C. Hepatocytes are apparently the primary site of injury in cases of LPD. LPDs, using epirubicin in a dose of 15-40 mg/m2 and Lipiodol in a dose of 0.02-0.25 ml/kg, proved to be safe for cirrhotic patients with HCC.
碘油化疗栓塞术——使用碘油加抗癌药物进行选择性区域癌症化疗（LPD）——可延长无法切除的肝细胞癌（HCC）患者的生存时间。为了加深对LPD对肝硬化肝脏影响的理解，我们开展了相关研究。43例肝硬化HCC患者接受了LPD治疗（表柔比星剂量为15 - 40mg/m²，碘油剂量为0.02 - 0.25ml/kg）。7例肝硬化HCC患者仅接受了肝血管造影，这些随机选取的受试者作为对照。在接受LPD治疗的43例患者中，23例属于Child A级，15例属于B级，5例属于C级。在血管造影前（术前）和血管造影后24小时（术后）采集每位患者的血样。比较两组患者以下参数的术后/术前比值：作为肝细胞损伤标志物的谷草转氨酶（sGOT）、谷丙转氨酶（sGPT）和乳酸脱氢酶（LDH）；作为肝细胞功能指标的总胆红素（t.胆红素）和肝促凝血酶原激酶试验（HPT）；用于检查胆管损伤的碱性磷酸酶和γ-谷氨酰转肽酶（γ-GTP）；以及用于确定内皮细胞功能的血清透明质酸水平。接受LPD治疗与未接受LPD治疗患者的血清GOT、GPT、LDH水平和HPT的术后/术前比值分别为1.32±0.59对0.92±0.09（P<0.001）、1.18±0.43对0.88±0.09（P<0.001）、1.11±0.20对1.00±0.07（P<0.05）和0.95±0.10对1.09±0.12（P<0.01）。对于Child A级、B级和C级患者，其他参数的术后/术前LPD比值、并发症发生率以及LPD治疗后的住院时间均无显著差异。在LPD病例中，肝细胞显然是主要的损伤部位。使用剂量为15 - 40mg/m²的表柔比星和剂量为0.02 - 0.25ml/kg的碘油的LPD，被证明对肝硬化HCC患者是安全的。
