Name: isolated hepatic perfusion as a treatment for liver metastases of uveal melanoma
Uploaded: 2015-01-25T14:00:00.000+00:00
Duration: 9 min 52 s
Description: Watch this Scientific Journal Video about Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma at JoVE.com

Lennart Wiman (photographer) is acknowledged for excellent video recording.

患者签署知情同意书，并研究在哥德堡大学批准的区域伦理审查委员会。 1.麻醉<ol><li>设置所有监测（心电图，血压袖带）17。 </li><li>插入一个硬膜外导管在较低到中等水平的胸椎17。 </li><li>诱导麻醉异丙酚2毫克/公斤，150微克芬太尼，罗库溴铵和0.6毫克/千克，通过一个预先插入外周静脉导管。 </li><li> Preoxygenate和插管病人。维持麻醉与七氟醚，氧气和空气17。 </li><li>插入双腔中心静脉导管和动脉导管。监测CVP和动脉压17。 </li></ol> 2.隔离容器的肝脏和插管<ol><li>管理100 IE /公斤肝素，并给予抗生素预防（ 如 160毫克的甲氧苄啶和800毫克磺胺甲恶唑的）。 </li><li>使用经皮Seldinger技术，将一个17星期五导管在股静脉和15神父导管在颈外静脉18。通过透视检查导管的位置。 </li><li>由一个L形切口，从剑突下中线进行剖腹，然后延伸到一权利肋下切口19。 </li><li>确认在腹部有一个完整的检查和触诊无肝外转移。 <ol><li>如果发现任何可疑病灶，冰冻切片检查恶性肿瘤。 </li><li>终止该程序是否有肝外表现（periaortal淋巴结肿大，腹部转移）的证据。淋巴结肿大的肝门不被视为禁忌。 </li></ol></li><li>通过将镰状韧带，左和右三角韧带和冠状韧带19调动肝脏。 </li><li>解剖腔静脉从静脉肾静脉开始了与腹膜后支流静脉结扎隔膜。 </li><li>确定右肾上腺静脉和放置血管环周围。 </li><li>确定正确的生殖腺静脉。剖析它的5-10厘米。广场周围的入口荷包缝合到腔静脉。 <ol><li>放置一个结扎远端的性腺静脉。用剪刀，从腔静脉打开生殖腺静脉3-5厘米。 </li><li>通过正确的生殖腺静脉插入一个18神父线增强导管放置尖retrohepatically上述肾静脉。 </li><li>周围放置性腺静脉结扎以固定导管的位置。 </li><li>验证的回血通过导管。 Heparinize导管18。 </li></ol></li><li>解剖肝十二指肠韧带和可视化的肝总动脉的胃十二指肠动脉和适当的肝动脉。 <ol><li>围绕所述共同肝ARTE地方容器循环RY和gastrodoudenal动脉。 </li><li>解剖门静脉和放置血管环周围。 </li><li>分离含有胆总管韧带的其余部分，并且包括在容器中循环这一切。 </li></ol></li><li>解除胃十二指肠动脉与容器循环。中断动脉流入后，用剪刀做一个切口。 <ol><li>插入8-12神父导管，其尖端插入肝固有动脉。安全与胃十二指肠动脉周围结扎的位置。 </li><li>确认回血在导管，然后heparinize它18。 </li></ol></li><li>素灌注系统与一个单元包装的红细胞，100毫升白蛋白（50克/升），加入100ml Tribonat（碳酸氢钠），2500单位的肝素（5000 IE /毫升）和250ml的晶体液。 </li><li>连接动脉和腔静脉导管的灌注系统，包括一个心脏肺机配备了一个滚子泵和加热器吨ogether一次性类型的静脉水库，氧合器和管道系统。 </li><li>连接股骨和外部颈静脉导管的静脉 - 静脉旁路泵组成的离心泵，以及一个加热器单元和启动旁路。 </li><li>通过拧紧围绕腔静脉infrahepatically以上肾静脉一个Rumel止血带和夹紧腔静脉suprahepatically使用Klintmalm血管钳完成肝脏的隔离。 <ol><li>紧绕胆总管，门静脉和右肾上腺静脉Rumel止血带，最后夹紧使用血管钳肝动脉。 </li></ol></li></ol> 3.灌注<ol><li>启动灌注和手动监控在静脉储血水平。调节流速直至稳态水平达到时，500-1,200毫升/分钟之间，通常的流速。 </li><li>将热敏电阻探测到左右肝叶和一个直接进入动脉导管。 </li><li>热灌注针对40 摄氏度的目标肝脏温度保持整个灌注这个温度。 </li><li>将闪烁探测器在静脉转流泵头上。 </li><li>校准泄漏监测系统，通过注射小剂量的10活度99m锝白蛋白（1毫升）进入体循环，并注册基线活性。 <ol><li>注入一个10倍高的剂量，100活度99m锝白蛋白（1毫升）中，进入肝灌注单元。 </li><li>记录从所述灌注系统的任何泄漏到全身循环如由闪烁探测器测量的增加的活性。 </li><li>记录从体循环到灌注系统如静脉储量增任何泄漏。 </li></ol></li><li>当建立的流量的稳态，无泄漏的存在和肝脏温度已达到40℃时，以一个剂量注入马法兰1毫克/公斤体重到灌注系统分成两个剂量给予30分钟分开。 </li></ol> 4.结束和灌注导管取出<ol><li>灌注的60分钟后，倒空从系统的灌注液和灌溉的肝脏用1,000ml的晶体。 </li><li>添加一个单位包装红细胞来灌注机组，注入到肝脏，然后停止灌注。 </li><li>松开Klintmalm夹，并从腔静脉的Rumel止血带。 </li><li>从肝十二指肠韧带松开止血带Rumel。 </li><li>从胃十二指肠动脉取出结扎。取出导管和结扎血管。 </li><li>释放来自肝动脉夹。 </li><li>从生殖腺静脉取出导管结扎血管。 </li><li>停止静脉 - 静脉转流泵和断开管。 </li><li>关闭腹部有一个不间断筋膜缝合，然后在皮内缝合皮肤。 </li><li>删除C在股骨和颈外静脉atheters和申请的局部压力为5分钟。 </li></ol> 5.术后护理<ol><li>拔管患者并传输到术后护理单元24小时。保持监测中央静脉压和动脉血压。 </li><li>病人转移到外科为典型的3-7天手术后的护理。 </li><li>继续与低分子量肝素（LMWH），在总共4周剂量的5000的IE /天。 </li></ol>

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	<li>Virgili, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+uveal+melanoma+in+Europe.">Incidence of uveal melanoma in Europe.</a> Ophthalmology. 114 (12), 2309-2315 (2007).</li><li>Pereira, P. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+and+emerging+treatment+options+for+uveal+melanoma.">Current and emerging treatment options for uveal melanoma.</a> Clinical Ophthalmology. 7, 1669-1682 (2013).</li><li>Bergman, L., Nilsson, B., Lundell, G., Lundell, M., Seregard, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ruthenium+brachytherapy+for+uveal+melanoma,+1979-2003:+survival+and+functional+outcomes+in+the+Swedish+population.">Ruthenium brachytherapy for uveal melanoma, 1979-2003: survival and functional outcomes in the Swedish population.</a> Ophthalmology. 112 (5), 834-840 (2005).</li><li>Diener-West, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+of+metastatic+disease+after+enrollment+in+the+COMS+trials+for+treatment+of+choroidal+melanoma:+Collaborative+Ocular+Melanoma+Study+Group+Report+No.+26.">Development of metastatic disease after enrollment in the COMS trials for treatment of choroidal melanoma: Collaborative Ocular Melanoma Study Group Report No. 26.</a> Archives of Ophthalmology. 123 (12), 1639-1643 (2005).</li><li>Kujala, E., Makitie, T., Kivela, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Very+long-term+prognosis+of+patients+with+malignant+uveal+melanoma.">Very long-term prognosis of patients with malignant uveal melanoma.</a> Investigative Ophthalmology &#38; Visual Science. 44 (11), 4651-4659 (2003).</li><li>Bedikian, A. Y., Papadopoulos, N., Plager, C., Eton, O., Ring, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phase+II+evaluation+of+temozolomide+in+metastatic+choroidal+melanoma.">Phase II evaluation of temozolomide in metastatic choroidal melanoma.</a> Melanoma Research. 13 (3), 303-306 (2003).</li><li>Kivela, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=vincristine,+lomustine+and+dacarbazine+(BOLD)+in+combination+with+recombinant+interferon+alpha-2b+for+metastatic+uveal+melanoma.">vincristine, lomustine and dacarbazine (BOLD) in combination with recombinant interferon alpha-2b for metastatic uveal melanoma.</a> European Journal Of Cancer. 39 (8), 1115-1120 (2003).</li><li>Schmittel, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Phase+II+trial+of+cisplatin,+gemcitabine+and+treosulfan+in+patients+with+metastatic+uveal+melanoma.">Phase II trial of cisplatin, gemcitabine and treosulfan in patients with metastatic uveal melanoma.</a> Melanoma Research. 15 (3), 205-207 (2005).</li><li>Leyvraz, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hepatic+intra-arterial+versus+intravenous+fotemustine+in+patients+with+liver+metastases+from+uveal+melanoma+(EORTC+18021):+a+multicentric+randomized+trial.">Hepatic intra-arterial versus intravenous fotemustine in patients with liver metastases from uveal melanoma (EORTC 18021): a multicentric randomized trial.</a> Annals Of Oncology : Official Journal Of The European Society for Medical Oncology / ESMO. 25 (3), 742-746 (2014).</li><li>Huppert, P. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transarterial+chemoembolization+of+liver+metastases+in+patients+with+uveal+melanoma.">Transarterial chemoembolization of liver metastases in patients with uveal melanoma.</a> European Journal Of Radiology. 74 (3), 38-44 (2010).</li><li>Klingenstein, A., Haug, A. R., Zech, C. J., Schaller, U. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radioembolization+as+locoregional+therapy+of+hepatic+metastases+in+uveal+melanoma+patients.">Radioembolization as locoregional therapy of hepatic metastases in uveal melanoma patients.</a> Cardiovascular and Interventional Radiology. 36 (1), 158-165 (2013).</li><li>Mariani, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+of+liver+metastases+from+uveal+melanoma:+16+years'+experience+at+the+Institut+Curie.">Surgical management of liver metastases from uveal melanoma: 16 years' experience at the Institut Curie.</a> European Journal Of Surgical Oncology : The Journal Of The European Society Of Surgical Oncology And The British Association of Surgical Oncology. 35 (11), 1192-1197 (2009).</li><li>Ausman, R. K., Aust, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolated+perfusion+of+the+liver+with+HN2.">Isolated perfusion of the liver with HN2.</a> Surgical Forum. 10, 77-79 (1960).</li><li>Dahl, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Interaction+of+hyperthermia+and+chemotherapy.">Interaction of hyperthermia and chemotherapy.</a> Recent results in cancer research. Fortschritte der Krebsforschung. Progres Dans Les Recherches Sur Le Cancer. 107, 157-169 (1988).</li><li>Barker, W. C., Andrich, M. P., Alexander, H. R., Fraker, D. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Continuous+intraoperative+external+monitoring+of+perfusate+leak+using+iodine-131+human+serum+albumin+during+isolated+perfusion+of+the+liver+and+limbs.">Continuous intraoperative external monitoring of perfusate leak using iodine-131 human serum albumin during isolated perfusion of the liver and limbs.</a> European Journal Of Nuclear Medicine. 22 (11), 1242-1248 (1995).</li><li>Olofsson, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolated+hepatic+perfusion+for+ocular+melanoma+metastasis:+registry+data+suggests+a+survival+benefit.">Isolated hepatic perfusion for ocular melanoma metastasis: registry data suggests a survival benefit.</a> Annals of Surgical Oncology. 21 (2), 466-472 (2014).</li><li>Redai, I., Emond, J., Brentjens, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anesthetic+considerations+during+liver+surgery.">Anesthetic considerations during liver surgery.</a> The Surgical Clinics of North America. 84, 401-411 (2004).</li><li>Sakai, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Insertion+and+management+of+percutaneous+veno-venous+bypass+cannula+for+liver+transplantation:+a+reference+for+transplant+anesthesiologists.">Insertion and management of percutaneous veno-venous bypass cannula for liver transplantation: a reference for transplant anesthesiologists.</a> Clinical Transplantation. 24 (5), 585-591 (2010).</li><li>Skandalakis, J. E., Skandalakis, L. J., Skandalakis, P. N., Mirilas, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hepatic+surgical+anatomy.">Hepatic surgical anatomy.</a> The Surgical Clinics of North America. 84 (2), 413-435 (1016).</li><li>Alexander, H. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+phase+I-II+study+of+isolated+hepatic+perfusion+using+melphalan+with+or+without+tumor+necrosis+factor+for+patients+with+ocular+melanoma+metastatic+to+liver.">A phase I-II study of isolated hepatic perfusion using melphalan with or without tumor necrosis factor for patients with ocular melanoma metastatic to liver.</a> Clinical Cancer Research : An Official Journal Of The American Association for Cancer Research. 6 (8), 3062-3070 (2000).</li><li>Alexander, H. R., Jr, , et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hyperthermic+isolated+hepatic+perfusion+using+melphalan+for+patients+with+ocular+melanoma+metastatic+to+liver.">Hyperthermic isolated hepatic perfusion using melphalan for patients with ocular melanoma metastatic to liver.</a> Clinical Cancer Research : An Official Journal Of The American Association For Cancer Research. 9 (17), 6343-6349 (2003).</li><li>Rizell, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolated+hepatic+perfusion+for+liver+metastases+of+malignant+melanoma.">Isolated hepatic perfusion for liver metastases of malignant melanoma.</a> Melanoma research. 18 (2), 120-126 (2008).</li><li>Iersel, L. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolated+hepatic+perfusion+with+200+mg+melphalan+for+advanced+noncolorectal+liver+metastases.">Isolated hepatic perfusion with 200 mg melphalan for advanced noncolorectal liver metastases.</a> Annals of Surgical Oncology. 15 (7), 1891-1898 (2008).</li><li>Carvajal, R. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+selumetinib+vs+chemotherapy+on+progression-free+survival+in+uveal+melanoma:+a+randomized+clinical+trial.">Effect of selumetinib vs chemotherapy on progression-free survival in uveal melanoma: a randomized clinical trial.</a> JAMA : the Journal Of The American Medical Association. 311 (23), 2397-2405 (2014).</li><li>Sharma, K. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hepatic+arterial+chemoembolization+for+management+of+metastatic+melanoma.">Hepatic arterial chemoembolization for management of metastatic melanoma.</a> AJR. American Journal Of Roentgenology. 190 (1), 99-104 (2008).</li><li>Eldredge-Hindy, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Yttrium-90+Microsphere+Brachytherapy+for+Liver+Metastases+From+Uveal+Melanoma:+Clinical+Outcomes+and+the+Predictive+Value+of+Fluorodeoxyglucose+Positron+Emission+Tomography.">Yttrium-90 Microsphere Brachytherapy for Liver Metastases From Uveal Melanoma: Clinical Outcomes and the Predictive Value of Fluorodeoxyglucose Positron Emission Tomography.</a> American Journal Of Clinical Oncology. , (2014).</li><li>Etten, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolated+hypoxic+hepatic+perfusion+with+orthograde+or+retrograde+flow+in+patients+with+irresectable+liver+metastases+using+percutaneous+balloon+catheter+techniques:+a+phase+I+and+II+study.">Isolated hypoxic hepatic perfusion with orthograde or retrograde flow in patients with irresectable liver metastases using percutaneous balloon catheter techniques: a phase I and II study.</a> Annals of Surgical Oncology. 11 (6), 598-605 (2004).</li><li>Ku, Y., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extracorporeal+adriamycin-removal+following+hepatic+artery+infusion:+use+of+direct+hemoperfusion+combined+with+veno-venous+bypass.">Extracorporeal adriamycin-removal following hepatic artery infusion: use of direct hemoperfusion combined with veno-venous bypass.</a> Nihon Geka Gakkai Zasshi. 90 (10), 1758-1764 (1989).</li><li>Curley, S. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hepatic+arterial+infusion+chemotherapy+with+complete+hepatic+venous+isolation+and+extracorporeal+chemofiltration:+a+feasibility+study+of+a+novel+system.">Hepatic arterial infusion chemotherapy with complete hepatic venous isolation and extracorporeal chemofiltration: a feasibility study of a novel system.</a> Anti-Cancer Drugs. 2 (2), 175-183 (1991).</li><li>Beheshti, M. V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+isolated+liver+perfusion+for+treatment+of+hepatic+malignancy:+preliminary+report.">Percutaneous isolated liver perfusion for treatment of hepatic malignancy: preliminary report.</a> Journal of Vascular And Interventional Radiology : JVIR. 3 (3), 453-458 (1992).</li></ol>

The authors have nothing to disclose.

转移性葡萄膜黑色素瘤有几个治疗方案。化疗6，免疫治疗23和靶向治疗24一直没能表现出改进的操作系统。患者很少肝转移，肝切除术是一种选择12。其他治疗方法包括肝动脉灌注化疗（HIA）9，肝动脉化疗栓塞（TACE）25和选择性体内放射治疗（SIRT）26。 国际水文计划是一个重大而复杂的外科手术，并因为由Ausman的第一份报告已经有许多发展的手术技术。 2004年，范埃顿和他的同事报道了第一个临床结果使用隔离缺氧肝脏灌注（IHHP）技术27。在20世纪90年代初，三个独立的小组开发利用体外chemofiltration 28-30一种新型的经皮肝动脉灌注（PHP）系统。没有研究比较这些技术的IHP已经执行。该报告至今似乎还没有被支持任何特定的技术。 患者选择的是这种治疗非常重要。因为它是一个局部治疗，不应该有证据肝外疾病。由于显影肝衰竭的风险，肝脏体积的不超过50％应该由肿瘤22所取代。患者应该有不错的表现状态（ECOG 0-1），无心脏 - ，lung-，kidney-或肝脏疾病手术后可能增加严重并发症的风险。 在最近的二相从我们组试验中，26个月的中位生存期结果表明，这意味着14个月与对照组相比，16一个潜在的生存受益。为了验证这一发现，一个多中心随机III期临床试验IHP和最佳另类护理（BAC）之间最近开始在斯堪的纳维亚（钪试验，ClinicalTrials号:NCT01785316）。上述BAC处理可以包括所有其它的治疗方案，无论是现有的或实验性的，与概念，即跨接不从BAC到IHP组允许的。入选标准包括:活检证实肝转移和PET-CT没有证据显示肝外肿瘤的表现。主要终点是24个月，次要终点包括反应率，无进展生存期和生活质量的整体生存。该计划包括为在5年78例。 总之，仍然存在没有治疗的III期临床试验已表现出任何延长总生存期患者的葡萄膜黑色素瘤肝转移。国际水文计划是在那里生存的潜在利益，目前正在调查在随机试验（钪试行）一个有趣的和有前途的局部治疗。

葡萄膜黑色素瘤是成人中最常见的原发性眼内恶性肿瘤，与发病率是最高的高加索人群1。局部治疗包括眼球摘除或局部斑块放射治疗2,3。无论局部治疗，转移性疾病最终会发展约35-50％的患者4,5。肝脏是转移的最常见的部位与本孤立肝转移患者约50％。中位总生存期（OS）的肝转移患者为6-12个月4。几个不同的系统性和区域性的治疗策略进行了探讨，但生存率没有改善2。 治疗全身化疗，单质（达卡巴嗪或替莫唑胺6）或联合治疗（BOLD方案7，吉西他滨与苏消安8），显示了较少的应答率则的10％。肝动脉内化疗（HIA）已经呈现出稍高总反应率相比全身化疗，但不增加整体存活率9。化学栓塞（TACE）与顺铂和卡铂显示出与9个月10中位生存在57％的患者有部分反应。选择性体内放射治疗（SIRT）已经显示与7个月11的中位存活的患者的62％的部分的响应。在肝切除术的研究，包括255例患者，14个月的总生存报告;在患者那里一个微观完整切除是可能的76，生存27个月12。 隔离肝脏灌注（IHP）是一个区域性的治疗选择，最初是由Ryan和Ausman发展。该技术背后的基本原理是通过外科手术隔离和灌注肝脏用高剂量的化疗剂的同时避免系统性至xicity 13。此外，并发热疗介导的化疗剂的变化在肿瘤血流和细胞膜通透性14增加的摄取。完整的血管隔离证实使用锝99标记的人血清白蛋白15放射性示踪技术。回顾II期临床研究已经显示为14个月（26与12个月）的潜在生存获益为接受国际水文计划相比，时间最长的幸存者，在瑞典16葡萄膜黑色素瘤肝转移患者。 在这里，我们提出国际水文计划的技术与目前的结果和未来前景简短评论。

<table><tbody><tr><td>Wire re-inforced catethers</td><td>Medtronic Inc, Minnesota, USA</td><td></td><td>12-18Fr</td></tr><tr><td>St&amp;ouml;ckert S5</td><td>Sorin Group, Mirandola, Italy</td><td></td><td>Heart-lung machine</td></tr><tr><td>Rotaflow</td><td>Maquet, Jostra Medizintechnik AG, Hirrlingen, Germany</td><td></td><td>Centrifugal pump</td></tr><tr><td>HU 35</td><td>Maquet cardiopulmonary AG, Hirrlingen, Germany</td><td></td><td>Heater unit</td></tr><tr><td>Flexbumin 200 g/l</td><td>Baxter Medical AB, Kista, Sweden</td><td></td><td></td></tr><tr><td>Tribonat</td><td>Fresenius Kabi AB, Uppsala, Sweden</td><td></td><td></td></tr><tr><td>Heparin LEO, 5000 IE/ml</td><td>LEO Pharma AB, Sweden</td><td></td><td></td></tr><tr><td>Ringer Acetate</td><td>Baxter Medical AB, Kista, Sweden</td><td></td><td></td></tr><tr><td>Vasculosis</td><td>Cis-Bio International, Gif-Sur-Yvette, France</td><td></td><td>99mTc-albumin</td></tr><tr><td>MedicView</td><td>SystemData AB, Gothenburg, Sweden</td><td></td><td>Leakage monitoring system</td></tr><tr><td>Alkeran</td><td>Aspen Europe GmbH, Bad Oldesloe, Germany</td><td></td><td>melphalan</td></tr></tbody></table>

isolated hepatic perfusion as a treatment for liver metastases of uveal melanoma

分离出的肝灌注（IHP）是一个过程，其中肝脏手术分离并灌注有高浓度的化疗剂美法仑。简单地说，该过程开始于从股静脉向外部颈静脉经皮静脉 - 静脉旁路的设置。经由剖腹，导管被插入到适当的肝动脉和腔静脉。门静脉和腔静脉，既supra-和infrahepatically，然后夹紧。的动脉和静脉导管被连接到心脏肺机和肝脏灌注美法仑（1毫克/千克体重）为60分钟。这种方式是可能的局部灌注用高剂量的化疗剂的肝癌，无泄漏到全身循环。 在以前的研究，包括患者的葡萄膜黑色素瘤孤立的肝转移，中33-100％的总反应率和9日和13月之间，中位生存期，已经报道了。此协议的目的是为了给如何执行过程描述清楚，并讨论国际水文计划作为葡萄膜黑色素瘤肝转移治疗方案。

初次报告包含的马法兰带或不带TNF-α治疗的22例患者。结果表明，总有效率为62％，其中两例CR（10％），以及11个月20中位总生存期。随后的研究报道了单独使用马法兰29例患者治疗的结果。该结果是用62％的总响应包括完整的10％响应和12个月的21位生存很相似。 在一项研究Rizell。等 ，被列入20例葡萄膜黑色素瘤。将患者分为三个不同时代的时间，结果显示，死亡率下降27％至0％。由于提高了病人的选择和技术开发22。 关于IHP知识主要基于较小追溯单机构系列，和已公布的结果列于表1中 。在总之，整体回应率是33-100％，其中0-20％的完全缓解率。在手术后的死亡率为6％，中位存活为12个月。 <table border="0" cellpadding="0" cellspacing="0"><tbody><tr><td> 笔者 </td><td> ñ </td><td> 类型 </td><td> ORR </td><td> CR </td><td> 中位生存期 </td><td> 死亡 </td></tr><tr><td> Alexander 等人，2000 </td><td> 22 </td><td> IHP </td><td> 62％ </td><td> 10％ </td><td> 11个月</td><td> 5％ </td></tr><tr><td> Alexander 等人，2003年</td><td> 29 </td><td> IHP </td><td> 62％ </td><td> 10％ </td><td> 12个月</td><td> 0％ </td></tr><tr><td>诺特等人，2003 </td><td> 8 </td><td> IHP </td><td> 50％ </td><td> 0％ </td><td> 10个月</td><td> 0％ </td></tr><tr><td> Pingpank 等 2005 </td><td> 10 </td><td> PHP </td><td> 50％ </td><td> 20％ </td><td> N / A </td><td> 0％ </td></tr><tr><td> Rizell 等人 2008年</td><td> 27 </td><td> IHP </td><td> 70％ </td><td> 7％ </td><td> 13个月</td><td> 22％ </td></tr><tr><td> Verhoef 等人 2008年</td><td> 4 </td><td> IHHP </td><td> 100％ </td><td> 0％ </td><td> 9个月</td><td> 0％ </td></tr><tr><td>面包车Iersel 等 2008 </td><td> 12 </td><td> IHP </td><td> 33％ </td><td> 0％ </td><td> 10个月</td><td> 0％ </td></tr><tr><td>面包车埃顿等人，2009年</td><td> 8 </td><td> IHHP </td><td> 37％ </td><td> 0％ </td><td> 11个月</td><td> 0％ </td></tr><tr><td>加权平均</td><td> 120 </td><td></td><td> 59％ </td><td> 7％ </td><td> 12个月</td><td> 6％ </td></tr><tr><td> Olofsson的等。 </td><td> 34 </td><td> IHP </td><td> 68％ </td><td> 12％ </td><td> 24个月60; </td><td> 0％ </td></tr></tbody></table> 表1:分离的肝灌注的结果与出版物报道的患者与分离出的肝灌注的不同方式处理过的分离的肝脏转移瘤的临床结果。 ORR =总有效率; CR =完全反应; IHP =隔离肝脏灌注; IHHP =缺氧隔离肝脏灌注; PHP =经皮肝动脉灌注; N / A =不适用。 <img alt="图1" src="/files/ftp_upload/52490/52490fig1.jpg" /> 图1:在静脉-静脉旁路系统和灌注系统的示意图图中的红色线表示在肝动脉导管和蓝色1表示在腔静脉的导管。它们被连接到由一个氧合器，一个滚子泵和一个加热单元的灌注系统。黑线代表静脉连接到一个滚子泵-venous旁路系统。

Watch this Scientific Journal Video about Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma at JoVE.com

Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

隔离肝脏灌注作为治疗葡萄膜黑色素瘤肝转移

Isolated hepatic perfusion (IHP) is a procedure where the liver is surgically isolated and perfused with a high concentration of the chemotherapeutic ...

isolated-hepatic-perfusion-as-treatment-for-liver-metastases-uveal

Nanyang Technological University

Research

JoVE Journal

Medicine

13.3K 次观看.  Institute of Clinical Sciences. Here, we present a protocol how to perform an isolated liver perfusion (IHP) with melphalan and we also discuss IHP as a treatment option for liver metastases of uveal melanoma.

视频: Isolated Hepatic Perfusion as a Treatment for Liver Metastases of Uveal Melanoma

Murine Model of Metastatic Liver Tumors in the Setting of Ischemia Reperfusion Injury

Liver ischemia and reperfusion (I/R) injury, a common clinical challenge, remains an inevitable pathophysiological process that has been shown to induce multiple tissue and organ damage. Despite recent advances and therapeutic approaches, the overall morbidity has remained unsatisfactory especially in patients with underlying parenchymal abnormalities. In the context of aggressive cancer growth and metastasis, surgical I/R is suspected to be the promoter regulating tumor recurrence. This article aims to describe a clinically relevant murine model of liver I/R and colorectal liver metastasis. In doing so, we aim to assist other investigators in establishing and perfecting this model for their routine research practice to better understand the effects of liver I/R on promoting liver metastases.

We describe in detail a clinically relevant colorectal cancer liver metastases (CRLM) tumor model and the influence of liver ischemia reperfusion (I/R) in tumor growth and metastasis. This model can help to better understand the mechanisms underlying surgery-induced promotion of liver metastatic growth.

缺血再灌注损伤中转移性肝肿瘤的模样

Liver ischemia and reperfusion (I/R) injury, a common clinical challenge, remains an inevitable pathophysiological process that has been shown to induce ...

科研

癌症研究

Generation of a Liver Orthotopic Human Uveal Melanoma Xenograft Platform in Immunodeficient Mice

In recent decades, subcutaneously implanted patient-derived xenograft tumors or cultured human cell lines have been increasingly recognized as more representative models to study human cancers in immunodeficient mice than traditional established human cell lines in vitro. Recently, orthotopically implanted patient-derived tumor xenograft (PDX) models in mice have been developed to better replicate features of patient tumors. A liver orthotopic xenograft mouse model is expected to be a useful cancer research platform, providing insights into tumor biology and drug therapy. However, liver orthotopic tumor implantation is generally complicated. Here we describe our protocols for the orthotopic implantation of patient-derived liver-metastatic uveal melanoma tumors. We cultured human liver metastatic uveal melanoma cell lines into immunodeficient mice. The protocols can result in consistently high technical success rates using either a surgical orthotopic implantation technique with chunks of patient-derived uveal melanoma tumor or a needle injection technique with cultured human cell line. We also describe protocols for CT scanning to detect interior liver tumors and for re-implantation techniques using cryopreserved tumors to achieve re-engraftment. Together, these protocols provide a better platform for liver orthotopic tumor mouse models of liver metastatic uveal melanoma in translational research.

Orthotopic human liver metastatic uveal melanoma xenograft mouse models were created using surgical orthotopic implantation techniques with patient-derived tumor chunk and needle injection techniques with cultured human uveal melanoma cell lines.

在免疫缺陷小鼠中生成肝脏正交人子宫黑色素瘤异种移植平台

In recent decades, subcutaneously implanted patient-derived xenograft tumors or cultured human cell lines have been increasingly recognized as more ...

Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography

Establishing experimental choroidal melanoma models is challenging in terms of the ability to induce tumors at the correct localization. In addition, difficulties in observing posterior choroidal melanoma in vivo limit tumor location and growth evaluation in real-time. The approach described here optimizes techniques for establishing choroidal melanoma in mice via a multi-step sub-choroidal B16LS9 cell injection procedure. To enable precision in injecting into the small dimensions of the mouse uvea, the complete procedure is performed under a microscope. First, a conjunctival peritomy is formed in the dorsal-temporal area of the eye. Then, a tract into the sub-choroidal space is created by inserting a needle through the exposed sclera. This is followed by the insertion of a blunt needle into the tract and the injection of melanoma cells into the choroid. Immediately after injection, noninvasive optical coherence tomography (OCT) imaging is utilized to determine tumor location and progress. Retinal detachment is evaluated as a predictor of tumor site and size. The presented method enables the reproducible induction of choroid-localized melanoma in mice and the live imaging of tumor growth evaluation. As such, it provides a valuable tool for studying intraocular tumors.

Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography

The present protocol describes the implantation and evaluation of melanoma in the murine choroid utilizing optical coherence tomography.

通过光学相干断层扫描 在 小鼠脉络膜中植入和评估黑色素瘤

Establishing experimental choroidal melanoma models is challenging in terms of the ability to induce tumors at the correct localization. In addition, ...

Normothermic Ex Vivo Liver Machine Perfusion in Mouse

This protocol presents an optimized erythrocytes-free NEVLP system using mouse livers. Ex vivo preservation of mouse livers was achieved by employing modified cannulas and techniques adapted from conventional commercial ex vivo perfusion equipment. The system was utilized to evaluate the preservation outcomes following 12 h of perfusion. C57BL/6J mice served as liver donors, and the livers were explanted by cannulating the portal vein (PV) and bile duct (BD), and subsequently flushing the organ with warm (37 &#176;C) heparinized saline. Then, the explanted livers were transferred to the perfusion chamber and subjected to normothermic oxygenated machine perfusion (NEVLP). Inlet and outlet perfusate samples were collected at 3 h intervals for perfusate analysis. Upon completion of the perfusion, liver samples were obtained for histological analysis, with morphological integrity assessed using modified Suzuki-Score through Hematoxylin-Eosin (HE) staining. The optimization experiments yielded the following findings: (1) mice weighing over 30 g were deemed more suitable for the experiment due to the larger size of their bile duct (BD). (2) a 2 Fr (outer diameter = 0.66 mm) polyurethane cannula was better suited for cannulating the portal vein (PV) when compared to a polypropylene cannula. This was attributed to the polyurethane material&#39;s enhanced grip, resulting in reduced catheter slippage during the transfer from the body to the organ chamber. (3) for cannulation of the bile duct (BD), a 1 Fr (outer diameter = 0.33 mm) polyurethane cannula was found to be more effective compared to the polypropylene UT - 03 (outer diameter = 0.30 mm) cannula. With this optimized protocol, mouse livers were successfully preserved for a duration of 12 h without significant impact on the histological structure. Hematoxylin-Eosin (HE) staining revealed a well-preserved morphological architecture of the liver, characterized by predominantly viable hepatocytes with clearly visible nuclei and mild dilation of hepatic sinusoids.

Normothermic Ex Vivo Liver Machine Perfusion in Mouse

A normothermic ex vivo liver perfusion (NEVLP) system was created for mouse livers. This system requires experience in microsurgery but allows for reproducible perfusion results. The ability to utilize mouse livers facilitates the investigation of molecular pathways to identify novel perfusate additives and enables the execution of experiments focused on organ repair.

小鼠常母离 体 肝机灌注

This protocol presents an optimized erythrocytes-free NEVLP system using mouse livers. Ex vivo preservation of mouse livers was achieved by employing ...

工程学

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn unresectable metastases into resectable ones. Some patients however, suffer from side effects or progression under systemic treatment. For patients with metastasized uveal melanoma there are no standard systemic therapy options. For patients without extrahepatic disease, isolated liver perfusion (IHP) may enable local disease control with limited systemic side effects. Previously, this was performed during open surgery with satisfying results, but morbidity and mortality related to the open procedure, prohibited a widespread application. Therefore, percutaneous hepatic perfusion (PHP) with simultaneous chemofiltration was developed. Besides decreasing morbidity and mortality, this procedure can be repeated, hopefully leading to a higher response rate and improved survival (by local control of disease). During PHP, catheters are placed in the proper hepatic artery, to infuse the chemotherapeutic agent, and in the inferior caval vein to aspirate the chemosaturated blood returning through the hepatic veins. The caval vein catheter is a double balloon catheter that prohibits leakage into the systemic circulation. The blood returning from the hepatic veins is aspirated through the catheter fenestrations and then perfused through an extra-corporeal filtration system. After filtration, the blood is returned to the patient by a third catheter in the right internal jugular vein. During PHP a high dose of melphalan is infused into the liver, which is toxic and would lead to life threatening complications when administered systemically. Because of the significant hemodynamic instability resulting from the combination of caval vein occlusion and chemofiltration, hemodynamic monitoring and hemodynamic support is of paramount importance during this complex procedure.

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

In this manuscript, we describe percutaneous isolated hepatic perfusion with simultaneous chemofiltration as treatment for unresectable liver metastases. This procedure is performed under general anaesthesia in the angiosuite by an experienced team, consisting of an interventional radiologist, a clinical perfusionist and anaesthesiologist.

经皮肝脏灌注（PHP）与美法仑作为囿于肝脏不能手术切除转移的治疗

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

医学

Visualization of Vascular and Parenchymal Regeneration after 70% Partial Hepatectomy in Normal Mice

A modified silicone injection procedure was used for visualization of the hepatic vascular tree. This procedure consisted of in-vivo injection of the silicone compound, via a 26 G catheter, into the portal or hepatic vein. After silicone injection, organs were explanted and prepared for ex-vivo micro-CT (&#181;CT) scanning. The silicone injection procedure is technically challenging. Achieving a successful outcome requires extensive microsurgical experience from the surgeon. One of the challenges of this procedure involves determining the adequate perfusion rate for the silicone compound. The perfusion rate for the silicone compound needs to be defined based on the hemodynamic of the vascular system of interest. Inappropriate perfusion rate can lead to an incomplete perfusion, artificial dilation and rupturing of vascular trees.
The 3D reconstruction of the vascular system was based on CT scans and was achieved using preclinical software such as HepaVision. The quality of the reconstructed vascular tree was directly related to the quality of silicone perfusion. Subsequently computed vascular parameters indicative of vascular growth, such as total vascular volume, were calculated based on the vascular reconstructions. Contrasting the vascular tree with silicone allowed for subsequent histological work-up of the specimen after &#181;CT scanning. The specimen can be subjected to serial sectioning, histological analysis and whole slide scanning, and thereafter to 3D reconstruction of the vascular trees based on histological images. This is the prerequisite for the detection of molecular events and their distribution with respect to the vascular tree. This modified silicone injection procedure can also be used to visualize and reconstruct the vascular systems of other organs. This technique has the potential to be extensively applied to studies concerning vascular anatomy and growth in various animal and disease models.

Tools used for visualizing vascular regeneration require methods for contrasting the vascular trees. This film demonstrated a delicate injection technique used to achieve optimal contrasting of the vascular trees and illustrate the potential benefits resulting from a detailed analysis of the resulting specimen using &#181;CT and histological serial sections.

之后，正常小鼠70％部分肝切除血管和实质再生的可视化

A modified silicone injection procedure was used for visualization of the hepatic vascular tree. This procedure consisted of in-vivo injection of the ...

Isolation of Regenerating Hepatocytes after Partial Hepatectomy in Mice

Partial hepatectomy has been widely used to investigate liver regeneration in mice, but the isolation of high yields of viable hepatocytes for downstream single-cell applications is challenging. A marked accumulation of lipids within regenerating hepatocytes is observed during the first 2 days of normal liver regeneration in mice. This so-called transient regeneration-associated steatosis (TRAS) is temporary but partially overlaps the major proliferative phase. Density-gradient purification is the backbone of most existing protocols for the isolation of primary hepatocytes. As gradient purification relies on the density and size of cells, it separates non-steatotic from steatotic hepatocyte populations. Therefore, fatty hepatocytes often are lost, yielding non-representative hepatocyte fractions. 
The presented protocol describes an easy and reliable method for the in vivo isolation of regenerating hepatocytes regardless of their lipid content. Hepatocytes from male C57BL/6 mice are isolated 24-48 h after hepatectomy by a classic two-step collagenase perfusion approach. A standard peristaltic pump drives the warmed solutions via the catheterized inferior vena cava into the remnant, using a retrograde perfusion technique with outflow through the portal vein. Hepatocytes are dissociated by collagenase for their release from the Glisson's capsule. After washing and careful centrifugation, the hepatocytes can be used for any downstream analyses. In conclusion, this paper describes a straightforward and reproducible technique for the isolation of a representative population of regenerating hepatocytes after partial hepatectomy in mice. The method may also aid the study of fatty liver disease.

Lipid-laden hepatocytes are inherent to liver regeneration but are usually lost upon density-gradient centrifugation. Here, we present an optimized cell isolation protocol that retains steatotic hepatocytes, yielding representative populations of regenerating hepatocytes after partial hepatectomy in mice.

小鼠肝部分切除术后再生肝细胞的分离

Partial hepatectomy has been widely used to investigate liver regeneration in mice, but the isolation of high yields of viable hepatocytes for downstream ...

<meta charset="utf8"></head><body>猪异位离体肝灌注模型的开发和验证

Porcine Normothermic Isolated Liver Perfusion

Porcine models of liver ex situ normothermic machine perfusion (NMP) are increasingly being used in transplant research. Contrary to rodents, porcine livers are anatomically and physiologically close to humans, with similar organ size and bile composition. NMP preserves the liver graft at near-to-physiological conditions by recirculating a warm, oxygenated, and nutrient-enriched red blood cell-based perfusate through the liver vasculature. NMP can be used to study ischemia-reperfusion injury, preserve a liver ex situ before transplantation, assess the liver's function prior to implantation, and provide a platform for organ repair and regeneration. Alternatively, NMP with a whole blood-based perfusate can be used to mimic transplantation. Nevertheless, this model is labor-intensive, technically challenging, and carries a high financial cost.
In this porcine NMP model, we use warm ischemic damaged livers (corresponding to donation after circulatory death). First, general anesthesia with mechanical ventilation is initiated, followed by the induction of warm ischemia by clamping the thoracic aorta for 60 min. Cannulas inserted in the abdominal aorta and portal vein allow flush-out of the liver with cold preservation solution. The flushed-out blood is washed with a cell saver to obtain concentrated red blood cells. Following hepatectomy, cannulas are inserted in the portal vein, hepatic artery, and infra-hepatic vena cava and connected to a closed perfusion circuit primed with a plasma expander and red blood cells. A hollow fiber oxygenator is included in the circuit and coupled to a heat exchanger to maintain a pO2 of 70-100 mmHg at 38 &#176;C. NMP is achieved by a continuous flow directly through the artery and via a venous reservoir through the portal vein. Flows, pressures, and blood gas values are continuously monitored. To evaluate the liver injury, perfusate and tissue are sampled at predefined time points; bile is collected via a cannula in the common bile duct.

<meta charset="utf8"></head><body>猪常态离体肝灌注

The porcine model of liver normothermic machine perfusion (NMP), described here, can be successfully used to study NMP as a preservation strategy, a tool for viability assessment, and a platform for organ repair. It holds a high translational value, however it is technically challenging and labor-intensive.

猪常态离体肝灌注

Porcine models of liver ex situ normothermic machine perfusion (NMP) are increasingly being used in transplant research. Contrary to rodents, porcine ...

隔离肝脏灌注作为治疗葡萄膜黑色素瘤肝转移

摘要

探索更多视频

此视频中的章节

缺血再灌注损伤中转移性肝肿瘤的模样

在免疫缺陷小鼠中生成肝脏正交人子宫黑色素瘤异种移植平台

通过光学相干断层扫描在小鼠脉络膜中植入和评估黑色素瘤

小鼠常母离体肝机灌注

经皮肝脏灌注（PHP）与美法仑作为囿于肝脏不能手术切除转移的治疗

之后，正常小鼠70％部分肝切除血管和实质再生的可视化

小鼠肝部分切除术后再生肝细胞的分离

猪常态离体肝灌注

猪常态离体肝灌注

猪常态离体肝灌注

隔离肝脏灌注作为治疗葡萄膜黑色素瘤肝转移

摘要

探索更多视频

此视频中的章节

缺血再灌注损伤中转移性肝肿瘤的模样

在免疫缺陷小鼠中生成肝脏正交人子宫黑色素瘤异种移植平台

通过光学相干断层扫描 在 小鼠脉络膜中植入和评估黑色素瘤

小鼠常母离 体 肝机灌注

经皮肝脏灌注（PHP）与美法仑作为囿于肝脏不能手术切除转移的治疗

之后，正常小鼠70％部分肝切除血管和实质再生的可视化

小鼠肝部分切除术后再生肝细胞的分离

猪常态离体肝灌注

猪常态离体肝灌注

猪常态离体肝灌注

通过光学相干断层扫描在小鼠脉络膜中植入和评估黑色素瘤

小鼠常母离体肝机灌注