Hohenberger W, Meyer T, Göhl J
Klinik und Poliklinik für Chirurgie, Universität Regensburg.
Chirurg. 1994 Mar;65(3):175-85.
Isolation perfusion was introduced in 1957 by Creech and Krementz for treatment of in-transit metastases from malignant melanoma of the limbs. The isolation of the extremity from the body circulation allows a high concentration of cytostatics without systemic side effects. In combination with hyperthermic tissue temperatures around 41.5 degrees C an additional effect can be expected. Regional metastasizing malignant melanomas with satellites, in-transit or lymph node metastases are generally accepted indications for isolation perfusion. There is still controversy about elective adjuvant perfusion in stage I melanoma. In spite of performing this treatment modality over 40 years in practice there are still many factors under discussion and many problems to be solved. The surgical procedure and techniqual aspects are described in detail. Krementz demonstrated long term survival rates between 19% and 53%. The patients treated in the Surgical Department of the University Hospital in Erlangen since 1975 with satellites and in-transit metastases had a 10-year survival rate of 48%. Considering the historical data of our patients without perfusion with a 10-year survival of 11% there is a highly significant statistical difference. In conclusion isolation perfusion is the therapy of choice in patients with locally metastasized malignant melanoma of the limbs.
1957年，克里奇和克雷门茨引入了隔离灌注法，用于治疗四肢恶性黑色素瘤的途中转移。将肢体与体循环隔离可使细胞抑制剂达到高浓度，且无全身副作用。结合约41.5摄氏度的组织高温，有望产生额外效果。伴有卫星灶、途中转移或淋巴结转移的局部转移性恶性黑色素瘤通常被认为是隔离灌注的适应症。对于I期黑色素瘤的选择性辅助灌注仍存在争议。尽管这种治疗方式在实践中已应用了40多年，但仍有许多因素有待讨论，还有许多问题需要解决。本文详细描述了手术过程和技术方面。克雷门茨证明长期生存率在19%至53%之间。自1975年以来，在埃尔朗根大学医院外科接受治疗的伴有卫星灶和途中转移的患者，其10年生存率为48%。考虑到我们未接受灌注治疗的患者的历史数据，其10年生存率为11%，存在高度显著的统计学差异。总之，隔离灌注是四肢局部转移性恶性黑色素瘤患者的首选治疗方法。
