Experimental and clinical studies of intrahepatic portal vein embolization for hepatocellular carcinoma

介入性血管造影术应用广泛，尤其是在恶性肿瘤的经导管动脉栓塞治疗中。作者提出了一种治疗门静脉阻塞型肝癌的新方法。该治疗可使肿瘤细胞完全缺血性坏死，并可通过引起非栓塞叶的代偿性肥大来扩大手术适应证。它有助于阻止肿瘤经门静脉播散，并有助于阻断癌栓的向心扩展。实验研究了该方法的可行性和安全性。制备了两种用于门静脉栓塞的材料，碘油-纤维蛋白粘合剂混合物（Lp-FiO 2）和碘油与2-氰基丙烯酸异丁酯（Lp-IBC）的混合物。25例门静脉栓塞，14例使用Lp-F，11例使用IBCh Lp-IBC。Lp-F在制备后30至90秒使用，这在体外研究中被发现是最好的。Lp-IBC可在制备后的任何时间使用。栓塞是安全可靠的，除了在两个案件的Lp-F，使用球囊导管的Lp-F和同轴导管的Lp-IBC。在用Lp-F栓塞的狗中，阻塞维持2至4周，并且在所有用Lp-IBC栓塞的狗中，阻塞维持4周。肉眼和组织学上的肝脏损伤均轻微。肝功能的变化和门静脉压力的升高是短暂的。作者得出结论，当使用试验材料时，肝内门静脉栓塞是可行的和安全的，并且可能是治疗肝细胞癌的有效方法。在临床病例中，Lp-FiO 2适用于中度闭塞，Lp-IBC适用于长期闭塞。应根据用途选择材料。

Interventional angiography is widely used, especially in transcatheter arterial embolization for the treatment of malignant tumors. The author has developed a new method for treatment of hepatocellular carclnoma in which the portal vein is occluded. The treatment can cause complete ischemic necrosis of the tumor cells together with arterial embolization, and can extend indications for surgery by causing compensatory hypertrophy of non-embolized lobe. It helps to prevent dissemination of the tumor via the portal velu, and helps to block centripetal extension of tumor thrombus. The feasibility and safety of this method were studied experimentally. Two kinds of materials were prepared for embolization of the portal vein, a Lipiodol-fibrin adhesive mixture (Lp-Fibrin), and a mixture of Lipiodol with isobutyl-2-cyanoacrylate (Lp-IBC). The portal vein was embolized in 25, 14 with Lp-F, and 11 IBCh Lp-IBC. Lp-F was used 30 to 90 seconds after preparation, which had been found to be best in an in vitro study. Lp-IBC could be used at any time after preparation. Embolization was done safely and reliably, except in two cases of Lp-F, by use of a balloon catheter for Lp-F and a coaxial catheter for Lp-IBC. The obstruction was maintained for two to four weeks in the dogs embolized with Lp-F, and for four weeks in all dogs embolized with Lp-IBC. damage in the liver was slight both macroscopically and histologically. Changes in liver function and elevation of the pressure of the porta vein were transient. The author concluded that intranepatic portal vein embolization was both feasible and safe when the materials tested were used, and could be an effective method for hepatocellular carcinoma. In clinical cases, Lp-Fibrin would be suitable for moderate-term occlusion, and Lp-IBC for long-term. The meterial should be selected with regard to the purpose.