Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma
Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma
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DOI：
10.3791/52490
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发表时间：
2015-01-01
影响因子：
1.2
通讯作者：
Bagge, Roger Olofsson
中科院分区：
文献类型：
--
作者：
Ben-Shabat, Ilan;Hansson, Christoffer;Bagge, Roger Olofsson
孤立肝灌注（IHP）是一种手术分离肝脏并灌注高浓度化疗药物melphalan的方法。简单地说，手术首先从股静脉到颈外静脉的经皮静脉-静脉搭桥开始。通过剖腹手术，将导管插入肝固有动脉和腔静脉。然后夹住肝上和肝下的门静脉和腔静脉。将动脉和静脉导管连接到心肺机，并向肝脏灌注melphalan （1mg /kg体重）60分钟。这样就可以用高剂量的化疗药物局部灌注肝脏，而不会渗漏到体循环。在先前的研究中，包括葡萄膜黑色素瘤肝转移患者，总有效率为33-100%，中位生存期为9至13个月。本方案的目的是给出如何执行程序的明确描述，并讨论IHP作为葡萄膜黑色素瘤肝转移的治疗选择。
Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic agent melphalan. Briefly, the procedure starts with the setup of a percutaneous veno-venous bypass from the femoral vein to the external jugular vein. Via a laparotomy, catheters are then inserted into the proper hepatic artery and the caval vein. The portal vein and the caval vein, both supra-and infrahepatically, are then clamped. The arterial and venous catheters are connected to a heart lung machine and the liver is perfused with melphalan (1 mg/kg body weight) for 60 min. This way it is possible to locally perfuse the liver with a high dose of a chemotherapeutic agent, without leakage to the systemic circulation.In previous studies including patients with isolated liver metastases of uveal melanoma, an overall response rate of 33-100% and a median survival between 9 and 13 months, have been reported. The aim of this protocol is to give a clear description of how to perform the procedure and to discuss IHP as a treatment option for liver metastases of uveal melanoma.