Interstitial hepatic artery occlusion

Interstitial hepatic artery occlusion, also known as temporary hepatic arterial debridement, was first initiated by Bengmark in 1974. The basic principle is to block the hepatic artery by gap, which can achieve the purpose of killing the tumor and avoid the massive necrosis of the liver tissue. Therefore, it is considered to be the fifth generation derivative technology of hepatic artery ligation. In 1974, Bengmark first used a nylon hepatic artery tourniquet, but the tourniquet was damaged by the hepatic artery and may form an aneurysm, and the blocking effect was difficult to control. In 1978, Domeiri and Mojab first used intra-arterial balloon catheters to repeatedly block the hepatic artery, but this method may cause complications such as hepatic artery thrombosis, catheter displacement or perforation of the vessel wall. By 1984, Persson et al. adopted a new type of hepatic artery blocker that could be buried under the skin, thus enabling the application of this technology. The hepatic artery blocker consists of a silicone sleeve with a water bladder, a hypodermic injection device, and a silicone catheter that connects the two. All devices are not exposed to the abdominal cavity, avoiding the chance of infection. The hemodynamics and biological basis of interstitial hepatic artery occlusion are: 1 interrupt the blood supply of liver tumor; 2 prevent the arterial collateral circulation rapidly formed by ischemia; 3 repeated ischemia and reperfusion can promote liver The tissue produces more oxygen-derived free radicals, and these oxygen free radicals have a killing effect on tumor cells; 4 the hepatic artery can maintain complete patency, which can be used as a pathway for hepatic arterial chemotherapy. Treatment of diseases: liver cancer primary liver cancer Indication Interstitial hepatic artery occlusion is applicable to: 1. Unresectable primary or secondary liver cancer, the tumor is confined to the liver. 2. Patients with recurrent hepatocellular carcinoma who have difficulty in resection. 3. The portal vein has no cancerous plug, no ascites and jaundice, and no metastasis of the hilar lymph nodes. 4. There is no severe varicose veins of the esophagus. Contraindications 1. Liver cancer combined with hepatic portal metastasis and hepatic hilar lymphadenopathy leads to difficulty in revealing the hepatic artery. 2. Liver cancer combined with distant metastasis, or with portal vein tumor thrombosis. 3. Patients who have undergone hepatic arterial chemoembolization in the past. 4. Patients with severe cirrhosis and severe esophageal varices. Surgical procedure 1. Exploring the liver and hepatic artery through the incision of the upper rectus abdominis or the inferior inferior costal margin. Pay particular attention to the presence or absence of vagus hepatic artery. The ligaments around the liver, including the left and right triangular ligaments, the coronary ligaments, the sacral ligaments and the liver and stomach ligaments, are fully freed from the bare liver area. If there is a vagus hepatic artery, it should be ligated and cut. Remove the gallbladder. 2. Separate the hepatoduodenal ligament, disconnect all connective tissue in the ligament, only the common bile duct, portal vein and hepatic artery, and free the hepatic artery to be about 2 cm long. 3. The arterial blocker cuff is wrapped around the proper artery of the liver and fixed, and the hypodermic injection device is buried next to the incision or under the costal margin. 4. Inject 1 to 2 ml of normal saline through a hypodermic injection device to fill the water capsule, press the proper artery of the liver until the distal end touches the beat, and extract the amount of water required for the saline recording. 5. If hepatic artery catheterization chemotherapy is performed at the same time, the gastroduodenal artery is isolated, the distal end is ligated, the catheter is inserted into the hepatic artery through the proximal end, and the catheter is double-ligated. The other end of the catheter is taken out of the body through the abdominal wall or connected to another subcutaneous injection device, which is also buried under the skin.