本研究は、復旦大学中山病院(2016ZSLC17)の臨床研究特別基金によって支援されました。著者らは、復旦大学中山病院の西林胡博士が英語執筆に対する非常に専門的な提案をしてくれたことに非常に感謝しています。

この単一センターの回顧研究は、復旦大学中山病院の地元の機関審査委員会によって承認されました。
1. インフォームド・コンセントの取得
<ol><li>TRA介入の前に、介入放射線科医(IRs)に、患者に対するTRAの利点および潜在的な合併症を説明してもらう。</li>
</ol>2. 患者の評価
<ol><li>インフォームド・コンセントを得た後、穿刺および缶詰の実現可能性についてRAを評価する。</li>
	<li>患者の病歴の総合的なレビューを行います。患者が重度の血管の強発性、重篤な末梢血管疾患、透析のための瘻孔、またはRA透析手術のための準備を有しているかどうかを確認する。これらは、TRA介入を受けている患者に対する相対的な禁忌である。</li>
	<li>RAの可視性を評価します。<ol>
<li>パルスオキシメトリーを使用してバーボー試験を行い、介入前に手側副動脈がどの程度目に見えるかを評価する。バーボーD波形はRAのカンヌレーションのための絶対的な禁忌と考えられています。</li>
		<li>バルボーC波形としてテストされた患者のために、前腕および手の副次循環の量についてのより信頼できる情報を提供するためにドップラー超音波検査を適用する。2mm未満の内径は禁忌と見なされます。 注:病歴評価およびRA評価後、禁忌患者は、イプシラテラRAを介して穿刺を控えるべきである。反側RAは、Barbeau試験評価を通じて特許であることが判明した場合、理想的な供給として機能する可能性があります。最初は、左側の RA が優先アクセス ルートとして選択されます。左のRAが不適当と判明した場合、右のRAが代替選択として機能する場合があります。</li>
	</ol>
</li>
</ol>3. 放射状動脈アクセス
<ol><li>患者を血管造影台の上の立場に置く。次に、左腕を患者の体に平行に置き、左ウエストに近づけ、カテーテルとワイヤーの配置を容易にし、オペレータの位置をTFAと同等にします。</li>
	<li>遠位RAパルスを触診でマークします。10%ポビドネヨウ素外科スクラブ液で皮膚表面をきれいにし、溶液を空気乾燥させます。手術用ドレープで左腕を覆います。<ol>
<li>潜在的な左RA穿刺障害の場合は、右腕または右のインジナル領域を殺菌してドレープすることによって代替アクセスルートを準備します。</li>
	</ol>
</li>
	<li>局所麻酔(すなわち、リドカイン1 mL2%)を適用する左RAの最も強力な脈動の軸に沿ってスタイロイドプロセスに近似。</li>
	<li>手首を伸ばし、変更されたセルディンガー技術を使用して20G針でRAを穿刺します。拍動性動脈血の戻りが観察されるとき、0.025インチ親水性ガイドワイヤーを導入する。<ol>
<li>ガイドワイヤーを引き込み、抵抗に遭遇した場合は針を再び取り付けます。ガイドワイヤーを挿入しないでください。デジタル減算血管造影(DSA)の助けを借りて、RAを強調し、親水性ガイドワイヤーを挿入するのに役立つコントラストの約1〜2 mLを注入します。</li>
	</ol>
</li>
	<li>アクセスが取得されたら、針を取り外し、ガイドワイヤーで4-フランスの親水性シースを導入します。シース挿入後、少量の動脈血を注射器で静かに汲み上げ、シース先端が血管内にあることを確認する。</li>
</ol>4. 抗凝固と血管拡張
<ol><li>血管拡張カクテル溶液(3,000 IUの未分離ヘパリン、0.1mgのニトログリセリン、リドカイン20mg)を10 mL用意します。</li>
	<li>8 mLの血管拡張カクテル溶液を、シースを通して0.5 mL/sの速度で投与する(図1)。 注:中等度または高い出血リスクを有する患者のためのヘパリンの用量を減らすか、または停止する。</li>
</ol>5. カテーテルの選択
<ol><li>4-フランス語、125センチの一般的なカテーテルと標準的な0.035インチx 180 cm親水性ワイヤーを使用して、鎖骨下動脈を横断し、下降大動脈を係合します。DSAフルオロソコピーを使用して、腕内のナビゲーション中に近位腋窩動脈を可視化し、動脈ループまたは血管損傷に対する潜在的な病変を避けます。 注:鎖骨下動脈には多くの動脈枝があります。血管造影誘導により、ガイドワイヤーカテーテルが逆行カテーテル法の間に副血管に入るのを防ぎます。いくつかの症例は、放射状動脈に動脈ループを有する。標準ワイヤがループを通過できない場合は、マイクロカテーテルと角度 0.016 インチまたは 0.018 インチマイクロワイヤの使用をお勧めします。</li>
	<li>4-フランス語、125 cmの一般的なカテーテルを標準の0.035インチワイヤーと組み合わせて使用して、ガイドワイヤーを下降大陸に向けて導くために横断アーチを交渉します。 注:大動脈と左鎖骨下動脈の間の角度が非常に鋭い場合、このターンを達成するためにコブラ2字型カテーテル(例えば、シモンズIまたはシモンズIIカテーテル)をお勧めします。</li>
	<li>下降大動脈のカテーテル後、同軸技術を介して共通のカテーテルを交換する。一般的なカテーテルが下降大間に挿入されたら、DSA透視検査の指導の下でセリアックトランクのカテーテルのためにカテーテル先端を腹腔内に操縦する。ほとんどの場合、セリアック幹、肝動脈、および優れた腸間膜動脈の血管造影をカテーテル化し、行うことが容易である。 注:セリアック動脈と下降大動脈の間の角度が非常に鋭い場合は、コブラカテーテルを使用して手順を完了します。</li>
	<li>肝塞栓術の場合、同軸技術を用いて超選択的カテーテル法および化学式化を行い、2.8-フランス語150cmマイクロカテーテルを、腫瘍に供給する肝動脈の標的枝に配置する(図2)。病気の負担と患者の好みに応じてTACEを実行します。</li>
	<li>十分な塞栓を確認するために高圧注入器を使用して、共通のカテーテルを介して血管造影を行います.カテーテル先端は通常、一般的な肝動脈に位置する。9~12 mLの造影剤を1sあたり3~4mLの割合で、蛍光顕微鏡時間は~15秒で注入します。次に、RAへの損傷を避けるためにガイドワイヤー上のカテーテルを取り外します。</li>
</ol>6. ラジアル動脈止血症
注: 非閉塞性止血症は、RAの愛息を維持するために特別な止血帯を使用して行われます(図3)。
<ol><li>残りの2mLの血管拡張カクテル溶液(セクション4)をRAシースを介して投与する。直後に、約5cmの鞘を取り出す。</li>
	<li>左手首の放射状アクセスサイトの上に止血帯を置き、付属の注射器を使用して空気で止血帯のエアバッグを十分に膨らまします。その後、シースを完全に取り外し、ゆっくりとエアバッグを収縮します。アクセス部位で漏れが見られる場合は、1 mLの空気をカフに戻します。通常、10~15 mLの空気をエアバッグに加え、止止めを維持します。</li>
	<li>出血や漏れがないことを確認します。同時に、遠位径動脈パルスが止血中に触知可能であることを確認する。パルスオキシメータ波形を使用して、左手親指の動脈波形を確認します。</li>
	<li>2時間ごとに2mLの空気嚢をゆっくりと6時間以下に膨らませる。止血帯が操作後6時間取り出されたら止血が成し遂がすることを再確認する。 注:デフレ時に穿刺部位からの出血や漏れが見られると、空気が30分間空気嚢に戻され、プロセスが繰り返されます。</li>
	<li>退院前に、BARBEAU検査を行い、RAの開腸を確認し、放射状動脈閉塞を有する患者を記録し、綿密にフォローアップする。</li>
</ol>7. フォローアップ
<ol><li>約1ヶ月後、TRA患者に左手首検査や脈拍検査を含む徹底的な身体検査を行う。潜在的に閉塞したRAを有する患者のために、前腕ドップラー超音波またはパルスオキシメトリーを使用して手の血液供給のその後の評価を行う。</li>
	<li>TACEの後にすべての患者を綿密にフォローアップします。新しい腫瘍結節がCTスキャンで明らかであり、最初の病変が再血管化したように見えた場合は、別のTACE治療を行う。</li>
</ol>

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<li>Du, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Transradial+access+chemoembolization+for+hepatocellular+carcinoma+in+comparation+with+transfemoral+access%5BTitle%5D)+AND+%22Translational+Cancer+Research%22%5BJournal%5D)">Transradial access chemoembolization for hepatocellular carcinoma in comparation with transfemoral access.</a> Translational Cancer Research. 8 (5), 1795-1805 (2019).</li>
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<li>Shiozawa, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Transradial+approach+for+transcatheter+arterial+chemoembolization+in+patients+with+hepatocellular+carcinoma+-+Comparison+with+conventional+transfemoral+approach%5BTitle%5D)+AND+%22Journal+of+Clinical+Gastroenterology%22%5BJournal%5D)">Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma - Comparison with conventional transfemoral approach.</a> Journal of Clinical Gastroenterology. 37 (5), 412-417 (2003).</li>
<li>Mitchell, M. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Systematic+review+and+cost-benefit+analysis+of+radial+artery+access+for+coronary+angiography+and+intervention%5BTitle%5D)+AND+%22Circulation%3A+Cardiovascular+Quality+and+Outcomes%22%5BJournal%5D)">Systematic review and cost-benefit analysis of radial artery access for coronary angiography and intervention.</a> Circulation: Cardiovascular Quality and Outcomes. 5 (4), 454-462 (2012).</li>
<li>Shoji, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Stroke+After+Percutaneous+Coronary+Intervention+in+the+Era+of+Transradial+Intervention%5BTitle%5D)+AND+%22Circulation%3A+Cardiovascular+Interventions%22%5BJournal%5D)">Stroke After Percutaneous Coronary Intervention in the Era of Transradial Intervention.</a> Circulation: Cardiovascular Interventions. 11 (12), 006761(2018).</li>
<li>Jurga, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Cerebral+microembolism+during+coronary+angiography%3A+a+randomized+comparison+between+femoral+and+radial+arterial+access%5BTitle%5D)+AND+%22Stroke%22%5BJournal%5D)">Cerebral microembolism during coronary angiography: a randomized comparison between femoral and radial arterial access.</a> Stroke. 42 (5), 1475-1477 (2011).</li>
<li>Bishay, V. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Transradial+Approach+for+Hepatic+Radioembolization%3A+Initial+Results+and+Technique%5BTitle%5D)+AND+%22AJR%3A+American+Journal+of+Roentgenology%22%5BJournal%5D)">Transradial Approach for Hepatic Radioembolization: Initial Results and Technique.</a> AJR: American Journal of Roentgenology. 207 (5), 1112-1121 (2016).</li>
<li>Bernat, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((ST-segment+elevation+myocardial+infarction+treated+by+radial+or+femoral+approach+in+a+multicenter+randomized+clinical+trial%3A+the+STEMI-RADIAL+trial%5BTitle%5D)+AND+%22Journal+of+the+American+College+of+Cardiology%22%5BJournal%5D)">ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMI-RADIAL trial.</a> Journal of the American College of Cardiology. 63 (10), 964-972 (2014).</li>
</ol>

WZとZPYによるコンセプトとデザインを学ぶ。ND、ZHZおよびMJYによるデータの取得;ZPYによって資金を得た。著者らは関連する財務上の開示を持っていません。

TRA介入療法は近年、特に診断および介入的な心臓病の手順12において、世界的に著しく成長している。また、末梢血管疾患介入に対する注目度が高まっている。手続き上の成功率を損なうことなく、TRAから心臓介入は、TFA13,14と比較して出血および血管合併症の割合を効果的に減少させることができる。TFAと比較して、TRAは処置後?...

肝細胞癌(HCC)は非常に一般的な悪性腫瘍であり、世界で6番目に高い発生率を有する。また、世界1の癌死亡率の第2位の原因です。治癒療法を受けることができる患者の5%~20%に過ぎないため、眼下血栓塞栓術(TACE)は、未分除菌性HCC2患者に対して最も一般的な緩和治療である。TACEは、中間段階3でHCC患者に対して最も一般的かつ効果的な治療アプローチとして認識されている。トランスフェモラルアクセス(TFA)ケマンボラ化は、TACE4の最も一般的なアプローチです。しかし、アクセス部位での出血や主要な血管合併症5を含むTFA介入に関連するリスクがある。これらの合併症は、長期の入院とコストの増加につながります。さらに、TFAは少なくとも6時間の固定化を必要とし、患者に対する不快感および不満を増加させる。
経放射型アクセス (TRA) は、経皮的冠動脈介入 (PCI) で 20 年以上5,6に使用されてきた代替アプローチです。TRA PCIには、プロシージャの快適性の向上、アクセス部位関連の出血の減少、主要な血管合併症の減少、および死亡率7、8の減少など、いくつかの利点があります。放射状動脈(RA)は、その表面的な位置7のためにアクセスし、穿刺が容易である。止血は介入後に行うのは簡単であり、厳格な不モリ化は9 .心臓カテーテル法におけるTRA介入の証拠を奨励しているにもかかわらず、現在までに末梢疾患介入においてTRAを使用した研究はごくわずかである。悪性肝腫瘍に対するTRA介入はさらにまれである。ここで、TRA肝塞栓の臨床実現可能性および安全性が分析される。提供されるステップバイステップのTRAプロトコルに関する1つの機関の経験も説明されています。

<table><tbody><tr><td>&lt;strong&gt;Reagents&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Embosphere</td><td>Merit</td><td>20173776165</td><td></td></tr><tr><td>Gelfoam</td><td>Alicon</td><td>20143771056</td><td></td></tr><tr><td>Heparin</td><td>Hepatunn</td><td>H51021209</td><td></td></tr><tr><td>Injection syringe</td><td>KDL</td><td>20163150518</td><td></td></tr><tr><td>Iodinated oil</td><td>Yantai Luyin Pharmaceutical Co.Ltd</td><td>H37022398</td><td></td></tr><tr><td>Lidocaine</td><td>Shandong Hualu Pharmaceutical Co.Ltd</td><td>H37022147</td><td></td></tr><tr><td>Lobaplatin</td><td>Hainan Changan International Pharmaceutical Co.Ltd</td><td>H20050308</td><td></td></tr><tr><td>Nitroglycerin</td><td>Brijing Yimin Pharmaceutical Co.Ltd</td><td>H11020289</td><td></td></tr><tr><td>Normal saline</td><td>Anhui Shuanghe Pharmaceutical Co.Ltd</td><td>H34023609</td><td></td></tr><tr><td>Pharmorubicin</td><td>Pfizer</td><td>H20000496</td><td></td></tr><tr><td>Ultravist 370</td><td>Bayer</td><td>H20171333</td><td></td></tr><tr><td>&lt;strong&gt;Material&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Hydrophilic Guide Wire</td><td>Merit</td><td>LWSTDA38180</td><td></td></tr><tr><td>Injection syringe</td><td>KDL</td><td>20163150518</td><td></td></tr><tr><td>Maestro Microcatheter</td><td>Merit</td><td>28MC24150SN</td><td></td></tr><tr><td>MPA1 (I) catheter</td><td>Cordis</td><td>451-406P0</td><td></td></tr><tr><td>Sheath Introducer</td><td>Merit</td><td>PSI-4F-11-035</td><td></td></tr><tr><td>Steerable Guidewire</td><td>Merit</td><td>TNR2411</td><td></td></tr><tr><td>TR Band</td><td>Terumo</td><td>XX*RF06</td><td></td></tr><tr><td>&lt;strong&gt;Equipment&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>DSA</td><td>Toshiba</td><td>INFX-9000V</td><td></td></tr><tr><td>Ultrasonic machine</td><td>SonoScape</td><td>20172231180</td><td></td></tr></tbody></table>

transradial access chemoembolization for hepatocellular carcinoma patients

動脈間化学化(TACE)は、中間段階で肝細胞癌(HCC)の治療に最も一般的なモダリティである。TACEは、典型的には、トランスフェモラルアクセス(TFA)を介して行われる。しかしながら、経放射状アクセス(TRA)は、合併症および死亡率の低下による冠動脈介入において好ましい。TRAの利点をTACEに適用できるかどうかは調査が必要です。
単一のセンターでTRA TACEを受けている患者は、遡及的に研究のために登録された。手続き上の詳細、技術的な成功、放射状動脈閉塞(RAO)率、およびアクセス部位関連出血合併症を評価した。2017年10月から2018年10月にかけて、112人の患者が160回のTRA TACE処置を受けた。全体的な技術的成功率は95.0%(152/160)でした。TRAからTFAへのクロスオーバー率は1.9%でした。いずれの場合も、アクセス部位関連の出血合併症は見つからなかった。無症候性RA閉塞は3人の患者(2.7%)で起こった。TFAと比較して、TRAはアクセス部位関連の出血の合併症を減らしながら安全および患者の満足度を高めることができる。さらに、TRAの介入は、高齢、肥満、または出血合併症のリスクが高い患者に利益をもたらす可能性があります。

2017年10月から2018年10月にかけて、112人の患者が160回のTRA TACE処置を受け、全体的な技術的成功率は95.0%(152/160)でした。8つのケースが技術的な失敗に見られました。このうち5例は左RA穿刺障害によって引き起こされ、その後右RAアクセスでTACEが成功した。他の3つのケースは、缶めの失敗によって引き起こされ、その後、右FAアクセスへのクロスオーバーによる介入に成功しました。FAアクセスへ...

Watch this Scientific Journal Video about Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients at JoVE.com

Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

動脈間化学塞栓術(TACE)は、肝細胞癌の中間段階における患者に対する標準的な治療法であり、典型的には大腿動脈へのアクセスを通じて行われる。経大的なアクセスと比較して、経放射状アクセス(TRA)は出血の合併症の率を減少させ、忍耐強い許容を改善できる。放射状動脈アクセスを介して動脈間化学式化を行う方法をここに提示する。

肝細胞癌患者に対する経放射型アクセスケミオボリ

Transarterial chemoembolization (TACE) is the most common modality for treatment of hepatocellular carcinoma (HCC) at the intermediate stage. TACE is ...

transradial-access-chemoembolization-for-hepatocellular-carcinoma

Research

JoVE Journal

Cancer Research

5.5K ビュー.  Fudan University. 動脈間化学塞栓術(TACE)は、肝細胞癌の中間段階における患者に対する標準的な治療法であり、典型的には大腿動脈へのアクセスを通じて行われる。経大的なアクセスと比較して、経放射状アクセス(TRA)は出血の合併症の率を減少させ、忍耐強い許容を改善できる。放射状動脈アクセスを介して動脈間化学式化を行う方法をここに提示する。

ビデオ: Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional&#160;(3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.

Dual-phase cone-beam computed tomography (DP-CBCT) is a useful intraprocedural imaging technique for transarterial chemo-embolization treatment with drug-eluting beads of hepatocellular carcinoma. DP-CBCT has been used to perform three major steps in oncologic interventional radiology: tumor localization (see), navigation and intraprocedural catheter guidance (reach), and intraprocedural evaluation of treatment success (treat).

デュアルフェーズコーンビームコンピュータ断層撮影法は、参照達し、薬剤溶出ビーズ塞栓化学及血塞栓中に肝細胞癌の治療に

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 ...

医学

Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy

Laparoscopic hepatectomy has been reported in many studies, and it is the mainstream method of liver resection. In some particular cases, such as when there are tumors adjacent to the cystic bed, surgeons cannot palpate the surgical margins through the laparoscopic approach, which leads to uncertainty about R0 resection. Conventionally, the gallbladder is resected first, and the hepatic lobes or segments are resected second. However, tumor tissues can be disseminated in the above cases. To address this issue, based on the recognition of the porta hepatis and intrahepatic anatomy, we propose a unique approach to hepatectomy combined with gallbladder resection by en bloc anatomic resection in situ. Firstly, after dissecting the cystic duct, without cutting the gallbladder primarily, the porta hepatis is pre-occluded by the single lumen ureter; secondly, the left hepatic pedicle is made free by the gap of the Laennec membrane and Hilar plate; thirdly, the assistant is asked to drag the fundus of the gallbladder, and the liver parenchyma tissue is resected using a harmonic scalpel along the ischemia line on the liver surface and intraoperative ultrasound. The whole middle hepatic vein (MHV) and its tributaries appear completely; lastly, the left hepatic vein (LHV) is disconnected, and the specimen is taken out from the abdominal cavity. The tumor, gallbladder, and other surrounding tissues are resected en bloc, which meets the tumor-free criterion, and a wide incisal margin and R0 resection are achieved. Therefore, the laparoscopic hepatectomy with the combination of the en bloc concept and anatomic resection is a safe, effective, and radical method with low postoperative recurrence and metastasis.

Numerous studies have demonstrated the advantages of anatomic resection. Nonetheless, whether anatomic resection can increase R0 resection rates remains controversial. Consequently, the present study describes an innovative procedure involving the en bloc concept combined with anatomic resection in laparoscopic hepatectomy, which can reduce postoperative recurrence and metastasis.

腹腔鏡下肝切除術における解剖学的切除と組み合わせたEnBloc概念の適用

Laparoscopic hepatectomy has been reported in many studies, and it is the mainstream method of liver resection. In some particular cases, such as when ...

がん研究

Transarterial Administration of Oncolytic Viruses for Locoregional Therapy of Orthotopic HCC in Rats

Hepatocellular carcinoma (HCC) is a disease with limited treatment options and poor prognosis. In recent years, oncolytic virotherapies have proven themselves to be potentially powerful tools to fight malignancy. Due to the unique dual blood supply in the liver, it is possible to apply therapies locally to orthotopic liver tumors, which are predominantly fed by arterial blood flow. We have previously demonstrated that hepatic arterial delivery of oncolytic viruses results in safe and efficient transduction efficiency of multifocal HCC lesions, resulting in significant prolongation of survival in immune competent rats. This procedure closely mimics the application of transarterial embolization in patients, which is the standard palliative care provided to many HCC patients. The ability to administer tumor therapies through the hepatic artery in rats allows for a highly sophisticated preclinical model for evaluating novel viral vectors under development. Here we describe the detailed protocol for microdissection of the hepatic artery for infusion of oncolytic virus vectors to treat orthotopic HCC.

Oncolytic virotherapies are under development as novel therapeutics for the treatment of hepatocellular carcinoma (HCC). Here we describe a method for locoregional therapy of HCC via hepatic arterial administration of oncolytic virus.

ラットにおける同所性肝細胞癌の局所領域治療のための腫瘍溶解性ウイルスのTransarterial管理

Hepatocellular carcinoma (HCC) is a disease with limited treatment options and poor prognosis.  In recent years, oncolytic virotherapies have proven ...

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.

肝臓に閉じ込められた切除不能な転移の治療として、メルファランとの経皮肝灌流（PHP）

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

Robotic Taj Mahal Hepatectomy for Hilar Cholangiocarcinoma

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Radical surgical resection is the only effective treatment option. In this study, a 32-year-old male patient with Bismuth Type IVa hilar cholangiocarcinoma underwent radical robotic resection of hepatic S4b, S5, and S1 (Taj Mahal hepatectomy) combined with regional lymphadenectomy, hilar bile duct reconstruction, and hepaticojejunostomy by the robotic surgical system. Postoperative pathological examination showed moderately-differentiated adenocarcinoma of the hilar bile duct. The surgical margins of the liver and bile ducts were negative. Recovery was smooth and the patient was discharged on the 17th postoperative day. The robotic surgical system and associated multiple instruments along with flexible and precise movements is suitable for the local hepatectomy around the porta hepatis, and delicate reconstruction of the hilar bile duct with a smaller diameter. This first clinical application study found that robotic Taj Mahal hepatectomy for hilar cholangiocarcinoma is safe and feasible and needs more experience for the evaluation of its long-term outcomes.

Robotic resection of hepatic S4b, S5, and S1 using the Taj Mahal procedure is feasible and safe for selected patients with hilar cholangiocarcinoma. The step-by-step details for this surgery are presented here.

肺門胆管癌に対するロボットタージマハル肝切除術

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Radical surgical resection is the only effective treatment option. In ...

<meta charset="utf8"></head><body>肝細胞癌におけるブリッジング療法としてのY-90 TAREおよびPD-1阻害

Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma

This study showcases a comprehensive treatment protocol for high-risk hepatocellular carcinoma (HCC) patients, focusing on the combined use of Y-90 transarterial radioembolization (TARE) and Programmed Cell Death-1 (PD-1) inhibitors as neoadjuvant therapy. Highlighted through a case report, it offers a step-by-step reference for similar therapeutic interventions. A retrospective analysis was conducted on a patient who underwent hepatectomy following Y-90 TARE and PD-1 inhibitor treatment. Key demographic and clinical details were recorded at admission to guide therapy selection. Y-90 TARE suitability and dosage calculation were based on Technetium-99m (Tc-99m) macroaggregated albumin (MAA) perfusion mapping tests. Lesion coverage by Y-90 microspheres was confirmed through single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging, and adverse reactions and follow-up outcomes were meticulously documented. The patient, with a 7.2 cm HCC in the right hepatic lobe (T1bN0M0, BCLC A, CNLC Ib) and an initial alpha-fetoprotein (AFP) level of 66,840 ng/mL, opted for Y-90 TARE due to high recurrence risk and initial surgery refusal. The therapy's parameters, including the lung shunting fraction (LSF) and non-tumor ratio (TNR), were within therapeutic limits. A total of 1.36 GBq Y-90 was administered. At 1 month post-therapy, the tumor shrank to 6 cm with partial necrosis, and AFP levels dropped to 21,155 ng/mL, remaining stable for 3 months. After 3 months, PD-1 inhibitor treatment led to further tumor reduction to 4 cm and AFP decrease to 1.84 ng/mL. The patient then underwent hepatectomy; histopathology confirmed complete tumor necrosis. At 12 months post-surgery, no tumor recurrence or metastasis was observed in follow-up sessions. This protocol demonstrates the effective combination of Y-90 TARE and PD-1 inhibitor as a bridging strategy to surgery for HCC patients at high recurrence risk, providing a practical guide for implementing this approach.

<meta charset="utf8"></head><body>肝細胞癌におけるネオアジュバント治療としてのY-90放射線塞栓術とPD-1阻害剤

This study illustrates the methodological potential of combining Yttrium-90 Trans-Arterial Radioembolization (Y-90 TARE) with an anti-PD-1 monoclonal antibody as an effective neoadjuvant strategy leading to hepatectomy in hepatocellular carcinoma (HCC) patients with a high initial recurrence risk. It emphasizes the safety, feasibility, and step-by-step procedural guidance of this approach.

肝細胞癌におけるネオアジュバント治療としてのY-90放射線塞栓術とPD-1阻害剤

This study showcases a comprehensive treatment protocol for high-risk hepatocellular carcinoma (HCC) patients, focusing on the combined use of Y-90 ...

Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb

Perihilar cholangiocarcinoma (pCCA) is a highly malignant and aggressive tumor, with radical resection being the only curative treatment available. With continuous advancements in laparoscopic techniques and instruments, laparoscopic radical surgery for pCCA is now considered technically safe and feasible. However, due to the high complexity of the surgery and the lack of evidence-based clinical support, laparoscopic radical surgery for type IIIb pCCA is performed only in a few large hepatobiliary centers. Current guidelines recommend left hemihepatectomy combined with total caudate lobectomy and standardized lymphadenectomy for resectable type IIIb pCCA. Therefore, in this article, we provide a detailed description of the surgical steps and technical points of complete laparoscopic left hemihepatectomy combined with total caudate lobectomy, regional lymphadenectomy, and right hepatic duct-jejunal Roux-en-Y anastomosis in patients with type IIIb pCCA, using fluorescence navigation technology to enhance surgical precision and safety. By adhering to standardized surgical procedures and precise intraoperative techniques, we offer an effective means to improve patient outcomes.

腹腔鏡下完全根治的切除術による肝心軟管癌IIIb型

Perihilar cholangiocarcinoma (pCCA) is a highly malignant and aggressive tumor, with radical resection being the only curative treatment available. With ...

Trans-Arterial Indocyanine Green Staining for Precise Anatomical Hepatectomy of Liver Segments VII and VIII

Anatomical hepatectomy for resectable hepatocellular carcinoma (HCC) is performed with precision using the Glissonean system, ultrasound imaging, and indocyanine green (ICG) fluorescence staining to define liver segments, enhancing surgical radicality and preserving liver volume. However, laparoscopic clamping and ultrasound-guided ICG staining for deep-seated tumors in liver segments VII and VIII pose challenges due to the depth of the Glissonean ducts and other technical limitations. This study aimed to overcome these obstacles by exploring a protocol using trans-arterial ICG staining, a technique specifically tailored for complex anatomical hepatectomy of liver segments VII and VIII. In this method, an interventionalist accessed the right femoral artery and advanced to the celiac trunk for arteriography, followed by strategic placement of a microcatheter into the tumor's blood supply vessel to facilitate surgical resection. During the operation, ICG was injected through the microcatheter to fluorescently label the tumor's liver segment, enabling precise anatomical resection under fluorescence guidance. This trans-arterial ICG staining approach allows for the accurate identification of tumor subsegments, facilitates complete resection, and optimizes liver function preservation, ultimately improving oncological outcomes without increasing surgical complication rates.

Laparoscopic anatomical hepatectomy has gained global recognition in liver surgery. However, delineating tumor boundaries in liver segments VII and VIII presents distinct technical challenges. This protocol utilizes trans-arterial indocyanine green (ICG) staining to accurately identify liver subsegments, facilitating complete tumor resection while preserving functional liver volume.

肝臓セグメントVIIおよびVIIIの正確な解剖学的肝切除術のための経動脈インドシアニングリーン染色

Anatomical hepatectomy for resectable hepatocellular carcinoma (HCC) is performed with precision using the Glissonean system, ultrasound imaging, and ...

肝細胞癌患者に対する経放射型アクセスケミオボリ

要約

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デュアルフェーズコーンビームコンピュータ断層撮影法は、参照達し、薬剤溶出ビーズ塞栓化学及血塞栓中に肝細胞癌の治療に

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ラットにおける同所性肝細胞癌の局所領域治療のための腫瘍溶解性ウイルスのTransarterial管理

肝臓に閉じ込められた切除不能な転移の治療として、メルファランとの経皮肝灌流（PHP）

肺門胆管癌に対するロボットタージマハル肝切除術

肝細胞癌におけるネオアジュバント治療としてのY-90放射線塞栓術とPD-1阻害剤

肝細胞癌におけるネオアジュバント治療としてのY-90放射線塞栓術とPD-1阻害剤

肝細胞癌におけるネオアジュバント治療としてのY-90放射線塞栓術とPD-1阻害剤

腹腔鏡下完全根治的切除術による肝心軟管癌IIIb型

肝臓セグメントVIIおよびVIIIの正確な解剖学的肝切除術のための経動脈インドシアニングリーン染色