Percutaneous isolated liver perfusion for treatment of hepatic malignancy: preliminary report.
Percutaneous isolated liver perfusion for treatment of hepatic malignancy: preliminary report.
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DOI：
10.1016/s1051-0443(92)71988-5
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发表时间：
1992-08-01
期刊：
影响因子：
--
通讯作者：
Ravikumar, T S
中科院分区：
文献类型：
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作者：
Beheshti, M V;Denny, D F Jr;Ravikumar, T S
原发性或转移性肝脏恶性肿瘤的化疗受到肿瘤反应差和剂量相关的全身毒性的限制。作为静脉或肝动脉化疗输注的替代方法，作者开发了一种经皮隔离肝脏灌流技术，可以在没有全身毒性的情况下将大剂量的化疗药物局部输送到肝脏。置入肝动脉灌注导管后，经对侧股静脉置入18-F双气囊导管进入下腔静脉。气囊在肝静脉上方和下方充气，从而隔离肝静脉流出。流出物通过导管中的窗口，并被泵入木炭血液灌流过滤器，在那里药物被去除。过滤后的血液通过颈内静脉返回给患者。在使用5-氟尿嘧啶(5-FU)的I期剂量递增研究中，对8名患者进行了15次治疗。虽然现在评估肿瘤对隔离肝脏灌流的反应还为时过早，但数据表明，该手术是安全的，患者可以耐受。药代动力学研究表明，5-FU的萃取率高达85%，药物渗漏到体循环的程度最低。这项技术显示出在改善肝脏肿瘤反应的同时降低全身毒性的潜力。
Chemotherapy for primary or metastatic hepatic malignancy is limited by poor tumor response and dose-related systemic toxicity. As an alternative to chemotherapy infusion by vein or by the hepatic artery, the authors have developed a percutaneous technique of isolated liver perfusion that allows the regional delivery of high-dose chemotherapy to the liver with little systemic toxicity. After placement of a hepatic artery infusion catheter, an 18-F double-balloon catheter is placed into the inferior vena cava through the opposite femoral vein. Balloons are inflated above and below the hepatic veins, thus isolating hepatic venous outflow. The effluent passes through fenestrations in the catheter and is pumped through charcoal hemoperfusion filters where the drug is removed. The filtered blood is returned to the patient through the internal jugular vein. Fifteen treatments have been conducted in eight patients in a phase I dose-escalation study with use of 5-fluorouracil (5-FU). While it is premature to assess tumor response to isolated liver perfusion, the data demonstrate that the procedure is safe and is tolerated by patients. Pharmacokinetic studies show a 5-FU extraction of up to 85%, with minimal drug leakage into the systemic circulation. This technique shows potential for improving liver tumor response while decreasing systemic toxicity.