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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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?...

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 border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Wire re-inforced catethers</td>
			<td>Medtronic Inc, Minnesota, USA</td>
			<td></td>
			<td>12-18Fr</td>
		</tr>
		<tr>
			<td>St&#246;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...

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 ...

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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.