Bianco S, Merkel C, Savastano S, Bellon S, Chiesura-Corona M, Bolognesi M, Miotto D, Enzo E, Feltrin G, Gatta A
Department of Clinical Medicine, University of Padua, Italy.
Gut. 1996 Aug;39(2):325-9. doi: 10.1136/gut.39.2.325.
Transcatheter arterial chemoembolisation, a procedure for the treatment of hepatocellular carcinoma, provokes a pronounced but transient increase in hepatic cytolysis parameters. A definite evaluation of the impairment of liver function after this treatment, performed by adequate techniques, is still lacking.
To assess and quantify the impairment of liver metabolic activity after arterial chemoembolisation in patients with cirrhosis. The variations of hepatic vein pressure gradient provoked by this procedure were evaluated.
15 patients with cirrhosis (Child's class A and B) and hepatocellular carcinoma.
17 transcatheter arterial chemoembolisations with epirubicin, iodised oil, and gelfoam were performed; liver function was assessed before, the following day, and after seven days measuring galactose elimination capacity; aminopyrine breath test was also performed in six patients before the procedure and seven days after. In 10 patients intrinsic hepatic clearance of indocyanine green and hepatic vein pressure gradient were measured by hepatic vein catheterisation before and 30 minutes after chemoembolisation.
Intrinsic hepatic clearance of indocyanine green decreased significantly from (mean (SEM)) 355 (140) ml/min to 277 (98) ml/min after the procedure (p = 0.0007). Galactose elimination capacity did not show significant changes, being 4.00 (0.90) mg/min/kg body weight at baseline, 4.20 (0.90) mg/min/kg body weight after one day, and 3.95 (0.87) mg/min/kg body weight seven days after chemoembolisation. Aminopyrine breath test was 2.31 (1.09)% and remained unchanged after treatment, being 2.39 (2.04)% at day 7. Baseline hepatic vein pressure gradient was 17.0 (5.5) mm Hg, and 14.4 (3.7) mm Hg 30 minutes after chemoembolisation (p = 0.09).
A single transcatheter chemoembolisation in cirrhotic patients was detected by galactose elimination capacity and aminopyrine breath test one and seven days after the procedure. Therefore it can be considered a safe therapeutic tool for hepatocellular carcinoma in Child's class A and B cirrhotic patients.
经动脉化疗栓塞术是一种治疗肝细胞癌的方法，可引起肝细胞溶解参数显著但短暂的升高。目前仍缺乏通过适当技术对该治疗后肝功能损害进行明确评估的方法。
评估并量化肝硬化患者经动脉化疗栓塞术后肝脏代谢活性的损害情况。评估该操作引起的肝静脉压力梯度变化。
15例肝硬化（Child A级和B级）合并肝细胞癌患者。
进行了17次使用表柔比星、碘化油和明胶海绵的经动脉化疗栓塞术；在术前、术后第1天和第7天通过测量半乳糖清除能力评估肝功能；还对6例患者在术前和术后7天进行了氨基比林呼吸试验。对10例患者在化疗栓塞术前和术后30分钟通过肝静脉插管测量吲哚菁绿的肝内清除率和肝静脉压力梯度。
吲哚菁绿的肝内清除率在术后显著降低，从（均值（标准误））355（140）ml/min降至277（98）ml/min（p = 0.0007）。半乳糖清除能力未显示出显著变化，基线时为4.00（0.90）mg/min/kg体重，术后1天为4.20（0.90）mg/min/kg体重，化疗栓塞术后7天为3.95（0.87）mg/min/kg体重。氨基比林呼吸试验术前为2.31（1.09）%，治疗后无变化，术后7天为2.39（2.04）%。基线肝静脉压力梯度为17.0（5.5）mmHg，化疗栓塞术后30分钟为14.4（3.7）mmHg（p = 0.09）。
通过半乳糖清除能力和氨基比林呼吸试验在术后1天和7天检测到肝硬化患者单次经动脉化疗栓塞术。因此，对于Child A级和B级肝硬化患者的肝细胞癌，它可被视为一种安全的治疗手段。
