Kanazawa S, Wright K C, Kasi L P, Charnsangavej C, Wallace S
Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
J Vasc Interv Radiol. 1993 Nov-Dec;4(6):759-66. doi: 10.1016/s1051-0443(93)71969-7.
Pigs were used to evaluate temporary segmental hepatic venous occlusion as a means of improving the selective delivery of therapeutic agents within the liver.
Hepatic angiography and scintigraphy were performed alone and in combination with hepatic venous occlusion.
Arteriograms obtained during venous obstruction demonstrated a greater number of peripheral arterial branches in the occluded area compared with the nonoccluded areas. A prolonged hepatogram showing hepatofugal opacification of the portal branches was observed in the occluded area. Microscopically, mild congestion of the sinusoids and central veins was seen immediately after 60-minute occlusion, but these changes were not evident 2 hours after balloon deflation. Severe congestion and focal hemorrhage were found in the occluded segment of the liver 2 hours after 90-minute venous occlusion. When the right or left hepatic vein was occluded during hepatic arterial infusion of technetium-99m macroaggregated albumin, there was a significant (P < or = .05) increase in the amount of radioactivity measured in the obstructed segment and a significant (P < or = .05) decrease in that found in the nonoccluded regions.
These results indicate that temporary segmental hepatic vein occlusion is safe for up to 60 minutes and may be clinically applicable as a means of improving the therapeutic index of agents within the liver when they are administered via concomitant hepatic arterial infusion.
利用猪评估暂时性节段性肝静脉闭塞作为一种改善治疗药物在肝脏内选择性递送的方法。
单独及联合肝静脉闭塞进行肝血管造影和闪烁扫描。
与未闭塞区域相比，静脉阻塞期间获得的动脉造影片显示闭塞区域的外周动脉分支数量更多。在闭塞区域观察到门静脉分支出现向肝外显影延长的肝影像。显微镜下，闭塞60分钟后立即可见肝血窦和中央静脉轻度充血，但球囊放气2小时后这些变化不明显。静脉闭塞90分钟后2小时，在肝脏的闭塞节段发现严重充血和局灶性出血。当在肝动脉注入99m锝标记的大颗粒白蛋白期间闭塞右或左肝静脉时，在阻塞节段测得的放射性量显著增加（P≤0.05），而在未闭塞区域测得的放射性量显著减少（P≤0.05）。
这些结果表明，暂时性节段性肝静脉闭塞在长达60分钟内是安全的，并且当通过肝动脉灌注同时给药时，作为一种改善肝脏内药物治疗指数的方法可能在临床上适用。
