Published online Dec 15, 1999. doi: 10.3748/wjg.v5.i6.506
Revised: September 6, 1999
Accepted: September 22, 1999
Published online: December 15, 1999
AIM: To improve the technique of intraportal embolization (PVE) therapy, a new embolic method, was devised and the safety, effectiveness and feasibility were evaluated.
METHODS: PVE with intraportal ethanol injection via a fine needl e was performed in 28 normal dogs, 22 SD rats, and 24 cirrhotic SD rats. After P VE, portography, histological and functional alteration of the liver were evaluated in dogs and rats, and the changes in portal hemodynamics as well as hepatic anatomy were observed in rats. In the clinical study, PVE by ethanol injection was performed in 61 patients with hepatocellular carcinoma under the guidance of portoechography with intraportal injection of CO2. The effect of PVE was evaluated by ultrasonography and laparotomy.
RESULTS: The effectiveness and toxicity were dependent on the do se of ethanol. In the dogs, 0.25 mg/kg of ethanol caused incomplete embolization with least liver damage, while 1.0 mg/kg induced complete embolization with a high mortality of 57.1% (4/7) due to respiratory arrest. The dose of 0.5 mg/kg resulted in complete embolization with slight toxicity to the liver. In the rats, the survival rate was 100% in normal group but 40.9% in cirrhotic models after ethanol injection by dose of 0.05 mg/100 g. PVE for cirrhotic rats with 0.03 mg/100 g of ethanol induced satisfactory embolization with significant hypertrophy in nonembolized lobes, and only slight damage to the hepatic parenchyma, and transient alteration in liver function, portal pressure and portal flow. In the clinical study, 12 cases with reverse portal flow were excluded judged by portoechography. Satisfactory embolization was gained in 90.2% (55/61) of the remaining patients determined by ultrasonography and surgery. All cases ran an uneventful postembolization course with no aberrant embolization.
CONCLUSION: PVE with intraportal ethanol injection of appropriate dosage via a fine needle is safe and effective and has several advantages comparing with transcatheter method. Portoechography is a mandatory approach for the prevention of aberrant embolization.