Yes. And it can be divided into two ways: mechanical and drug.
mechanically, the ancient representative was (surgical) hepatic artery ligation, and now it is (interventional) hepatic artery chemoembolization.
in order to analyze the above-mentioned"grain-cut"treatment, it is necessary to mention the"food supply"strategy for tumors. It is the stubbornness and complexity of tumor nutrition that determines that the current clinical antivascular therapy can only be controlled and can not be eradicated.
through the circulatory system (mainly through arterial blood) to transport nutrients (oxygen is not major, tumor anoxic), is the most efficient mode of supply in the body. When the tumor is very small, it can still obtain nutrition through diffusion and normal circulation. However, the metabolism and division of tumor is faster than that of normal tissue, the material consumption is already large, and the energy consumption is wasteful (because it is anaerobic), so the nutritional demand is much higher than that of normal tissue. When the tumor grows a little bigger, it must acquire the ability to"promote angiogenesis"in order to survive and reproduce better (natural selection).
(there should be a picture of tumor angiogenesis.
therefore, this ability has become one of the six major features of tumors (which were later supplemented by 10 features).
(there should be DSA pictures and CT pictures.
Let's talk about surgical ligation, which is direct and rough: the ligation of the blood vessels of an organ.
Why are organ blood vessels rather than tumor blood vessels? Because the performance-to-price ratio is too low and even the performance-to-price ratio may be negative. Itself is a palliative means, further fine ligation can not increase the effect, but further increase the trauma. In addition, it also involves the important principle of tumor surgery: the tumor-free principle.
(there should be a schematic diagram of the safe area of tumor surgery.
in fact, in the organs that supply blood in the tree, if the tumor is limited and can be ligated, it means that it can be removed. Ligation causes ischemia of the tumor, which can lead to ischemia of the organs. If organ necrosis occurs, the gain may outweigh the loss. Fortunately, there are two types of counterexamples: one is reticular blood supply, and the other is multiple blood supply.
(there should be a schematic diagram of tree, mesh and blood supply.
the shortcomings of ligation of reticular blood supply organs are obvious: anatomy determines that the body can be compensated naturally through the existing blood vessels after ligation, and the normal human body can do so, and the ability of promoting blood vessels of tumor only helps.
the organs with double blood supply are represented by the liver, which is much more interesting: the liver is supplied by the hepatic artery and portal vein, and when the liver cancer develops to an incurable degree, it is almost entirely supplied by the hepatic artery. Therefore, if the hepatic artery is ligated and the portal vein is preserved, the tumor can be cut off and the normal liver can survive. This is the theoretical basis of hepatic artery ligation.
at first, however, people did not expect that the liver seemed to be a tree-shaped blood supply organ, and there were a lot of ways of transportation in the back. Lateral branch of liver (right inferior phrenic artery is relieved), subcapsular communication, peribiliary vascular network. Although there have been"film wrapped liver"this attempt to prevent the emergence of physiological compensation, but on the whole still can not solve the problem of low utility and great damage.
the one who really sentenced the ligation of hepatic artery to death is the interventional embolization which belongs to the same mechanical approach.
puncture from groin or upper limb, insertion of catheter and guide wire operation, removal of tube at the end of operation, only needle hole the size of 1-2mm was left on the body surface. The injury is much smaller than general anesthesia.
intervention allows complete angiography of the required blood vessels to distinguish which blood vessels are associated with the tumor, and now catheters can penetrate into the careless branches of the 1mm (thinner catheters can be deeper) to complete embolization without affecting other blood vessels that supply normal tissue. It can not only protect normal tissue as much as possible, but also allow more serious embolization of tumor-related blood vessels.
(there should be an overselected diagram.
in addition to minimally invasive and fine, the concept of"ligation of blood vessels"has also changed. With the compensatory ability of the body and tumor, only blocking blood vessels is not enough, compensation is very easy. Interventional embolization has used embolization agent to reach the level of less than 100 μ m, and Japanese scholars who are good at refinement have put forward the degree of portal vein embolization through hepatic artery. In fact, it is embolized to the level of tumor microcirculation: only when the embolization of the peripheral blood vessels inside and around the tumor can be achieved, can the curative effect be better.
even so, it took 20 years for interventional embolization to be recognized worldwide. Looking back at the surgical ligation, it's almost impossible to look at it. What's more, surgical ligation will inevitably affect the catheter entry path of interventional embolization, but also can not be done.
(by the way, interventional embolization tests the technical level more,"can do"and"do well"are two completely different things. Any intelligence, normal communication of people, with a special person to learn, zero basis can also be a month to internal meeting. But it may not be able to achieve good results. The previous 20 years to be recognized, in addition to the equipment at that time is not precise enough, there are also operational and conceptual problems. Some live treasures who do not let patients go out for treatment on the grounds that"we can do it, too."it's really.
Interventional embolization is a good thing, but it is still a local treatment. And only"block", regardless of the body and tumor compensation. In fact, an increase in some angiogenic markers can be detected after interventional embolization, indicating"revenge"after treatment. For systemic and sustained antivascular therapy, it is the turn of anti-vascular targeted drugs.
at present, the most widely used anti-vascular target is VEGF-related. VEGF plays an important role in the process of angiogenesis, and the related drugs are also effective in the treatment of tumor. There are two kinds of drugs which are widely used in China.
<After all, antivascular therapy is aimed at the"environment", not the"tumor"itself, and can only be controlled and not killed.
the other is oral targeted drugs for VGEF receptors, which is a little more complicated, and is different from bevacizumab in terms of efficacy, therapeutic status, drug resistance, miss and so on, but in view of the questions raised by the subject, it is more or less the same.