Roversi R, Ricci S, Rossi G, Roversi M, Cavallo G
Servizio di Radiologia Diagnostica, Ospedale Bellaria C.A. Pizzardi, Bologna.
Radiol Med. 1997 Sep;94(3):220-5.
We report four cases of advanced malignant cancer of the gallbladder treated with hypoxic hepatic perfusion.
Hypoxic hepatic perfusion is currently used to treat diffuse hepatic metastases: the common hepatic artery is occluded with a balloon catheter and then a large amount of antiblastic solution is infused into the liver. Hypoxia and slow flow increase the effect of the drug on neoplastic tissue. Two sessions were performed in three patients with an interval ranging 2-4 months, while one patient underwent a single session. The drug was Mitomycin C, whose dose ranged 20-40 mg (mean: 30 mg). Blood filtration was performed after one of the six procedures only and can be considered unnecessary.
Acute gastric bleeding appeared in a patient after the embolization of the right gastric artery with bucrylate during the first session performed to avoid drug reflux into gastric wall arteries. No other technical or clinical complications occurred. An objective morphological response (tumor necrosis or reduction in size > 50%) was observed in all patients after the first session. CT findings were stable in two of three patients submitted to a second session, while local progression was observed in the other patient. Complete clinical response was achieved in all symptomatic patients. No WHO toxicity was observed.
The rate of positive morphological and/or clinical responses after hypoxic perfusion was very high in our experience, even though our series was small. Recurrences were found in two patients some months later, which suggests the need of long-term follow-up. Hypoxic perfusion can be nevertheless considered as a new and interesting therapeutic approach for advanced malignant gallbladder cancer, with a strong short-term effect on the lesion and good results on clinical symptoms.
我们报告4例采用低氧肝灌注治疗的晚期胆囊恶性肿瘤病例。
低氧肝灌注目前用于治疗弥漫性肝转移：用球囊导管阻断肝总动脉，然后将大量抗瘤溶液注入肝脏。缺氧和血流缓慢可增强药物对肿瘤组织的作用。3例患者进行了2个疗程，间隔2 - 4个月，1例患者进行了1个疗程。所用药物为丝裂霉素C，剂量为20 - 40mg（平均：30mg）。6次操作中仅1次操作后进行了血液滤过，可认为无必要。
1例患者在首次治疗时为避免药物反流至胃壁动脉而用丁基丙烯酸酯栓塞胃右动脉后出现急性胃出血。未发生其他技术或临床并发症。首次治疗后所有患者均观察到客观形态学反应（肿瘤坏死或大小缩小>50%）。接受第2个疗程的3例患者中2例CT表现稳定，另1例观察到局部进展。所有有症状的患者均实现了完全临床缓解。未观察到世界卫生组织（WHO）分级的毒性反应。
根据我们的经验，尽管我们的病例系列较小，但低氧灌注后形态学和/或临床阳性反应率非常高。几个月后2例患者出现复发，这表明需要长期随访。然而，低氧灌注可被视为晚期恶性胆囊癌一种新的、有趣的治疗方法，对病变有很强的短期效应，对临床症状效果良好。
