摘要
目的总结多学科协作团队(multidisciplinary team,MDT)模式下复发转移高危肝细胞癌患者诊断和治疗的全程管理经验,提高临床医师对“全程管理”这一理念的认识,力求提高肝细胞癌患者的生存率。方法对四川大学华西医院(简称“我院”)肝脏外科收治的1例复发转移高危肝细胞癌患者的临床病理资料进行回顾性分析。结果该例患者为一52岁男性患者,因“上腹不适1+个月,查见肝脏占位1+周”入我院后诊断为肝细胞癌伴肝内转移,为中国肝癌分期方案Ⅱb期、巴塞罗那肝癌分期B期。在我院MDT模式下讨论后,先后实施了两次转化治疗,成功降期后行同种异体肝移植术,术后未发生严重并发症,于肝移植术后第23天出院。术后随访至今,先后发现肺部细菌和真菌感染及肺部转移灶,先后经抗感染治疗及靶向治疗联合放射治疗后明显缓解,患者术后至今已生存34个月,目前仍规律随访中。结论对于复发转移高危肝细胞癌患者,采用MDT模式对患者进行全程管理具有较好的临床获益。通过MDT模式将肝细胞癌的诊断、治疗、随访等环节有机整合,并对患者的诊疗方案进行动态调整,实现肝细胞癌患者的全程管理,力求提高肝细胞癌患者的生存率及改善患者的生存质量。
Objective To summarize the experience of the whole process management of hepatocellular carcinoma(HCC)patients with high-risk of recurrence and metastasis based on the multidisciplinary team(MDT)mode,and to improve the clinicians'understanding of the concept of whole process management,so as to improve the survival rate of patients with HCC.Method The clinicopathologic data of a HCC patient with high-risk of recurrence and metastasis admitted to the Division of Liver Surgery,Department of General Surgery,West China Hospital of Sichuan University were retrospectively analyzed.Results A 52-year-old male patient was diagnosed with HCC with intrahepatic metastasis(China liver cancer stagingⅡb,Barcelona Clinic Liver Cancer stage B)after admission due to“epigastric discomfort for 1+-month and liver occupying for 1+-week”.Through discussion by the MDT mode,the allogeneic liver transplantation was performed after successful downstaging following two conversion therapies.No serious complications occurred after operation,and the patient was discharged on the 23rd day after operation.Up to now,pulmonary bacterial and fungal infections and pulmonary metastases had been found during the postoperative followup.After anti-infective therapy and targeted therapy combined with radiotherapy,the patient was significantly relieved,had survived for 34 months after operation,and was still under regular follow-up.Conclusions For HCC patients with high-risk of recurrence and metastasis,MDT mode has a good clinical benefit for the whole process management of patient.Through the MDT model,the diagnosis,treatment,and follow-up of HCC are organically integrated,and the patient's diagnosis and treatment plans are dynamically adjusted to realize the whole process management of HCC patient,and to raise the survival rate and improve quality of life of HCC patient.
作者
杨泓钊
刘畅
蒋涵羽
杨雨
周继陶
谢坤林
杨家印
吴泓
YANG Hongzhao;LIU Chang;JIANG Hanyu;YANG Yu;ZHOU Jitao;XIE Kunlin;YANG Jiayin;WU Hong(Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Liver Transplant Center,Transplant Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Division of Liver Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of Radiology,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Division of Abdominal Tumor Multimodality Treatment,Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2023年第6期653-659,共7页
Chinese Journal of Bases and Clinics In General Surgery
关键词
肝细胞癌
肝移植
全程管理
多学科协作团队
hepatocellular carcinoma
liver transplantation
whole process management
multidisciplinary team
