Experimental study to establish new therapeutic method for liver cancer with hepatic cirrhosis-gradual interruption of hepatic blood flow

对于不能切除的肝肿瘤，我们提出了一种新的手术治疗方法，即门脉分支结扎术，用ameroid缩窄器逐渐闭塞肝动脉分支。我们以44只杂种犬为研究对象，探讨了这种新的治疗方法在临床应用的可能性。试验组设计如下：A组；假手术（n=6）。B组；70%肝切除术（n=10）。C组；70%的肝脏通过门静脉分支结扎切断门静脉血流（n=15）。D组；门脉分支结扎术，逐渐闭塞供应约70%肝脏的肝动脉分支（n=13）。A、B、C组分别有1只狗死于感染和肝坏死。D组术后第8天死亡1只（未见肝坏死）。在8周内，我们观察肝功能的变化，包括ICG Rmax。在手术和牺牲时（初次手术后8周）测定肝组织血流量（激光多普勒测深法）和肝细胞活力（MTT法）。D组血清GOT、GPT水平显著升高（最高，为10万U/I），但ICG Rmax变化与C组基本相同，手术应激小于肝切除组。C、D组未闭塞叶肝细胞活力显著高于闭塞叶肝细胞活力（P<0.001）。d组未闭塞肺叶存活率显著高于术前（p<0.01）。D组闭塞肺叶萎缩、局灶性坏死，未闭塞肺叶再生、肥厚。与C组和B组相比，D组肝细胞肥大和再生明显增强（即使在闭塞的肺叶中，肝细胞也出现肥大）。这些发现提示了其临床应用的可能性，不仅可以作为抗癌治疗，还可以作为增加残肝储备功能的术前治疗。少

For the surgical treatment of unresectable hepatic tumor, we devised a new method whereby portal branch ligation with gradual occlusion of hepatic arterial branch by ameroid constrictor.We investigated the possibility of clinical application of this new therapeutic method using forty-four mongrel dogs. Experimental group was designed as follows. Group A ; sham operation (n=6). Group B ; 70 percent hepatectomy (n=10). Group C ; 70 percent of the liver was deprived of portal blood flow by portal branch ligation (n=15). Group D ; portal branch ligation with gradual occlusion of hepatic arterial branch which supplying about 70 percent of the liver (n=13). In A, B and C group, one dog died of infection and hepatic necrosis, respectively. In group D, one dog died on eighth post operative day (but we could not find the evidence of hepatic necrosis). During eight weeks, we observed the changes of hepatic function test including ICG Rmax. Hepatic tissue blood flow (Laser Doppler Verocimetry) an … More d viability of isolated hepatocytes (MTT assay) was measured at the time of operation and sacrifice (eight weeks after initial operation).Marked increase of serum GOT and GPT level was observed in group D (maximum, >10,000 U/I), although the changes in ICG Rmax were almost the same as group C, and the surgical stress was less than hepatectomy group. In group C and D, the viability of hepatocytes of non occluded lobes were significantly higher than occluded ones (P<0.001). In group d, the viability of non occluded lobes was significantly higher than preoperative value (p<0.01). In group D the occuluded lobes showed atrophy and focal necrosis, and non occluded lobes showed regeneration and hypertrophy. Comparing with group C and B, hypertrophy and regeneration seemed greater in group D (even in occluded lobes, hypertrophy of hepatocytes was noted). These findings indicate the possibility of clinical application not only as anti cancer therapy, but also as preoperative treatment that increases remnant hepatic reserve function. Less