钇-90微球放射性肝段切除——钇-90微球放射栓塞系列回顾(九)

Yttrium-90 microsphere radiative segmental hepatectomy. A series review of radioembolization with yttrium-90 microspheres(part Ⅸ )

钇-90(^(90)Y)微球放射性肝段切除(radiation segmentectomy)的概念是由美国西北大学肝癌协作小组在放射性肝叶切除(radiation lobectomy)的基础上,于2011年首先提出。将^(90)Y微球灌注的范围限制在2个肝段以内,在总的剂量不变或增加的情况下对肝脏恶性肿瘤进行高度选择性治疗。这种局部高剂量的方法在提高肿瘤对治疗反应的同时,明显降低了临床的并发症与不良反应。在影像学上,接受^(90)Y微球灌注组织的解剖肝段发生萎缩;同时,对侧肝叶发生不同程度的增生。这一新的治疗概念被称为放射性肝段切除并受到了医学界的广泛关注。现将^(90)Y放射性微球进行肝段切除的方法进行详细介绍,同时对现有文献所报道的临床结果进行总结和评价。

The concept of 90Y microsphere radiation segmentectomy was first proposed in 2011 by the Northwestern University cooperative group on liver cancer based on their work on radiation lobectomy.Using superselective technique with and without increasing the total radiation dose, they performed radioembolization therapy by limiting the 90Y microsphere perfusion area no more than two hepatic segments.This localized high dose treatment method not only improves the tumor response to radiation, but also significantly reduces clinical complications and side effects. From imaging analysis, hepatic segmental atrophy may be demonstrated in the areas that were treated with 90Y microspheres, while hypertrophy of liver parenchyma may occur in the opposite anatomic locations where radiation therapy was not applied. This new concept of therapy is named Radiation Segmentectomy, which has recently received considerable attraction.This review will describe the details of the 90Y microsphere radiation segmentectomy technique and analyze the results from current available of literature.