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

介入血管造影被广泛应用，特别是在经导管动脉栓塞治疗恶性肿瘤中。作者提出了一种治疗门静脉闭塞的肝细胞癌的新方法。结合动脉栓塞治疗可引起肿瘤细胞完全缺血性坏死，并可通过引起未栓塞的肺叶代偿性肥大扩大手术适应症。它有助于防止肿瘤通过门静脉扩散，并有助于阻止肿瘤血栓向心扩展。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，一种是脂醇-纤维蛋白粘合剂混合物（Lp-Fibrin），另一种是脂醇-2-氰基丙烯酸酯异丁酯（Lp-IBC）混合物。25例、14例用Lp-F栓塞门静脉，11例用Lp-IBC栓塞门静脉。Lp-F在制备后30 ~ 90秒使用，在体外研究中发现这是最好的。Lp-IBC制备后可随时使用。栓塞是安全可靠的，除了两例Lp-F，使用球囊导管用于Lp-F和同轴导管用于Lp-IBC。用Lp-F栓塞的狗阻塞维持了2 - 4周，所有用Lp-IBC栓塞的狗阻塞维持了4周。肝脏损伤在宏观和组织学上都很轻微。肝功能的改变和门静脉压力的升高是短暂的。作者认为，在使用所试验材料时，肝内门静脉栓塞术是可行和安全的，是治疗肝细胞癌的有效方法。在临床病例中，Lp-Fibrin适用于中期闭塞，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.