阿帕替尼联合肝动脉化疗栓塞术治疗BCLC B/C期肝癌的临床疗效

目的 探讨阿帕替尼联合经肝动脉化疗栓塞术(TACE)治疗巴塞罗那临床肝癌分期系统(BCLC)B/C期肝癌的安全性及有效性.方法 采用回顾性研究方法收集自2017年8月至2019年8月在湖北医药学院附属医院就诊的BCLC分期为B期或C期肝癌病人的临床资料进行研究,经过筛选后最终有58例病人纳入研究,根据治疗方法不同分为暴...     

巨大肝细胞癌根治性切除术后肝内多发转移并门静脉癌栓转化治疗：1例MDT讨论

目的 探讨多学科协作团队（multidisciplinary team,MDT）模式在肝细胞癌根治性切除术后复发的诊断和治疗中的价值。方法 回顾性分析四川省人民医院肝胆外科收治的1例巨大肝细胞癌根治性切除术后早期肝内多发转移并门静脉癌栓患者的临床病理资料。结果 患者系中年男性，巨大肝细胞癌（66 mm×60 mm×102 mm大小）根治性切除术后1个月时发现肝内多发转移并门静脉右支癌栓。经MDT讨论及评估后，采用肝动脉灌注化疗联合免疫治疗和靶向治疗（化疗方案采用FOLFOX，免疫治疗药物为信迪利单抗，靶向药物为仑伐替尼），进行了3次转化治疗后肝内病变大部分液化坏死并明显缩小或消失，再次经MDT讨论并评估后行根治性手术切除，术后病理检查结果提示肉芽肿性炎伴坏死，未见确切肝细胞性肝癌成分。术后6个月时复查未见肿瘤复发。结论 对于巨大肝细胞癌根治性肝切除术后早期肝内多发转移并门静脉癌栓者，行肝动脉灌注化疗联合免疫治疗和靶向治疗仍有机会获得手术治疗机会。MDT模式可为此类患者制定最优化的治疗方案，为患者带来更好的临床结局。     

MDT主导的BCLC B期肝右叶原发性巨块型肝癌TACE术后外科根治性切除的时机探讨

目的探讨巴塞罗那分期(BCLC)B期原发性肝癌肝动脉化疗栓塞术(TACE)后外科根治性切除的最佳时机及手术方式选择。方法对重庆医科大学附属第二医院于2017年10月收治的1例BCLC B期患者开展MDT讨论。该患者术前诊断为肝右叶原发性巨块型肝癌并周围卫星结节及肝左内叶转移结节(BCLC B期),并在前2个月内先后行2次TACE术,通过MDT讨论为其制定开腹前入路右半肝切除+左内叶肿瘤剜除术的手术方案。结果 MDT讨论结果:患者通过2次TACE,肝右叶肿瘤萎缩,肝左叶明显增生,患者获得了外科手术切除机会;经过精心围手术期管理及术中手术风险控制,患者手术顺利,术后痊愈,无并发症发生。结论部分BCLC B期肝脏原发性巨块型肝癌患者通过TACE治疗可以通过获得二期外科根治性切除的机会,临床工作中应当管理好这部分患者,力争获得良好疗效。     

巴塞罗那C期肝癌靶向联合免疫降期转化后实施左半肝切除术一例

患者男性,54岁,诊断为肝左叶肝癌并肝内多发转移伴门静脉主干及左支癌栓(巴塞罗那分期为C期,门静脉癌栓皿型)。该患者手术不可切除,也不符合经导管肝动脉栓塞化疗适应证,故选择抗血管生成靶向药物阿帕替尼联合程序性死亡蛋白-1抗体治疗。经过6个周期治疗,肝左叶主病灶明显缩小,门静脉癌栓从门静脉主干退至门静脉左支内,肝内转移病灶消失,经评估后成功施行了荧光腹腔镜左半肝切除术。     

肝动脉化疗栓塞联合系统治疗肝细胞癌术后复发及腹腔淋巴结转移的临床疗效

我国肝癌患者诊断时分期较晚, 病史较长, 5年生存率较低。国内外指南关于晚期肝癌局部治疗指征不同。肝动脉化疗栓塞的应用给晚期肝癌患者带来治疗新机会。原发性肝癌肝内复发病灶和肝外转移病灶存在肿瘤异质性, 导致对免疫治疗反应存在差异, 所以肝动脉化疗栓塞联合全身系统治疗, 更有益于延长患者生存时间。笔者报道1例晚期肝细胞癌术后复发及腹腔淋巴结转移患者应用肝动脉化疗栓塞联合放疗及阿替利珠单克隆抗体+贝伐珠单克隆抗体治疗的临床经验。其研究结果显示:患者短期内肿瘤得到控制, 取得良好的临床疗效。     

多学科联合治疗原发性巨大肝癌1例

目的探讨建立多学科综合治疗团队(multi-disciplinary team,MDT)在诊治原发性巨大肝癌中的作用和意义。方法对重庆医科大学附属第二医院肝胆外科于2018年7月收治的1例巨大肝癌患者展开MDT讨论,并复习相关文献,对巨块型肝癌的治疗方式进行总结。结果患者系老年男性,3年前初次就诊诊断为:肝右叶原发性肝细胞癌(小肝癌),拒绝行手术治疗,出院后自行口服中药。此次再次就诊时,患者的肝右叶肿瘤直径增大至10 cm左右,经MDT讨论后初步制定治疗方案为经肝动脉化疗栓塞(TACE)联合外科根治性手术。患者在14周内先后行2次TACE后,肝右叶肿瘤明显萎缩,肝左叶显著增生。于入院后5个月经再次MDT讨论后行经腹腔镜右半肝切除术。手术过程顺利,手术历时270 min,术中出血量约500 mL,予以输注悬浮红细胞400 mL。术后发生一过性肝功能衰竭,经保肝、对症支持治疗后于术后12 d康复出院。术后4个月复查腹部CT检查提示肝左叶明显增生,肿瘤无复发征象。继续随访。结论对于暂时无根治性手术指征的巨大肝癌患者,经过TACE治疗后部分患者可获得二期手术根治性切除机会。临床工作中应灵活应用MDT诊疗方式并贯彻巨大肝癌患者治疗的始终,为患者制定最佳的治疗方案。     

中国肝癌分期-Ⅲb期肝细胞癌转化治疗后行左半肝根治切除1例

患者男性,51岁,因体检发现肝内占位性病变3个月入院。完善相关检查,初始诊断：左半肝肝癌伴肝外转移(巴塞罗那临床肝癌分期C期、中国肝癌分期Ⅲ-b期),乙型病毒性肝炎肝硬化。经程序性死亡蛋白-1抑制剂与酪氨酸激酶抑制剂转化治疗后,复查影像学检查肝外转移病灶消失,原发病灶变小,降期成功。经评估可实施根治性切除,并成功施行开...     

犬肝动脉门静脉栓塞治疗肝细胞癌的实验研究和临床应用

肝细胞癌的根治性切除术是唯一能提供治愈可能的治疗方法。能切除的肝癌仅约25％。对那些在就诊时就失去手术机会的病人,肝动脉和门静脉分期栓塞能使肿瘤缩小,症状缓解,寿命延长。动物实验显示肝动脉与门静脉同时栓塞部分的肝脏坏死。50例经手术探查已不能切除的肝细胞癌病人,行肝动脉与门静脉分期化疗栓塞(碘化油-阿霉素),耐受手术良好,是肝癌姑息性治疗的新途径。     

肝细胞肝癌经肝动脉化疗栓塞联合索拉非尼降期后二期切除的初步报告

目的探讨不可一期切除肝细胞肝癌(hepatocellular carcinoma,HCC)经导管肝动脉化疗栓塞(transcatheter hepatic arterial chemoembolization,TACE)联合索拉非尼(Sorafenib)降期治疗后,二期再行根治性切除的可行性。方法回顾性分析2010年3月至2015年1月在南方医科大学南方医院肝胆外科经TACE及口服分子靶向药物索拉非尼治疗、成功降期后再行二期切除的21例HCC病人的临床资料。该组病人平均年龄45.5岁(20~67岁),肝切除手术后持续服用索拉非尼。结果该组病人经TACE联合口服索拉非尼成功降期,降期治疗所需时间平均为52.3 d。降期后实施左、右半肝切除分别为5例和3例,扩大左半肝切除1例,扩大右半肝切除1例,肝脏区段切除11例。术中平均出血量为356.3 ml(150~1 200 ml),平均手术时间为243.3 min(145~365 min)。经过12~62个月随访(中位随访时间为30.1个月),1、2、3年的无瘤存活率分别为76.2%、52.4%、43.6%,复发后病人再次接受TACE、放疗、射频消融等综合治疗者5例,接受再次手术切除的病人3例,1、2、3年总生存率分别为85.7%、71.4%、57.1%。结论 TACE联合口服索拉非尼全身治疗,可使部分初期不可切除肝癌成功降期,降期后接受外科根治性切除手术,初步效果令人鼓舞。     

合理选择原发性肝癌的治疗方法

由于现代科学技术的进步 ,原发性肝癌 (下称肝癌 )的诊断难题已基本解决 ,而治疗仍在不断的探索中。为提高肝癌的疗效 ,目前已有许多治疗方法在临床应用中。然而 ,从肝癌治疗方法发展的整个历程中可以发现 ,至今没有一种方法能适应每个病人而都能获得理想满意的疗效。肝癌的治疗从 5 0年代的全身化疗 ,60年代初尝试手术切除 ,即规则性肝叶切除 ,到后来的不规则性肝叶切除、局部切除 ,亚段肝切除 ,复发再切除 ,大肝癌治疗缩小后的 期切除 ,不能切除之肝癌行术中肝动脉结扎、栓塞、皮下化疗泵置入 ,还有经肝动脉插管化疗栓塞、经皮无水酒精注…     

Are gastric metastases of renal cell carcinoma really rare? A case report and systematic review of the literature

IntroductionRenal cell carcinoma (RCC) represents above 3 % of all cancers. At diagnosis, above 25 % of patients with RCC present an advanced disease. Gastric metastasis of RCC is associated with poor outcome. We report the case of a patient treated for a gastric metastasis of RCC and we conducted a systematic review of the literature to report all published cases of RCC patients with gastric metastasis.Case presentationIn December 2010, a 61-year-old man was treated by open partial nephrectomy for a localized right clear cell RCC. In September 2018, a metachronous gastric metastasis was found on CT scan. The lesion was located on the lesser curvature of the stomach, measuring 4.5 cm long axis. No other secondary lesions were identified. A laparoscopic wedge resection, converted to laparotomy was performed. Two years later, in September 2020, a CT scan was performed, revealing a 17 mm adenopathy behind the hepatic hilum and a surgical management was performed, including a lymph node dissection of the hepatic hilum and the hepatic artery. Actually, he remains healthy.Clinical discussion and conclusionOur systematic review suggests that solitary gastric metastasis of RCC are scarce. In comparison of patients with multiple metastatic sites, the median survival of patients with solitary gastric metastasis is longer.     

结直肠癌肝转移多学科综合治疗的建立和推广

结直肠肝转移是非常常见而又可以有效治疗的晚期肿瘤疾病.对结直肠癌肝转移的治疗会牵涉到多个临床学科.因此目前各国包括我国的临床诊治指南中都要求采用多学科综合诊治（MDT）对结直肠肝转移进行治疗.本文对结直肠癌肝转移的多学科综合诊治的建立,组织,运行的基本要求提出建议.     

结直肠癌同时性肝转移治疗46例分析

目的:探讨结直肠癌同时性肝转移的有效治疗方法。方法:对1996～2004年收治的46例结直肠癌同时性肝转移的临床资料和随访资料进行回顾性分析。根据治疗方法的不同分为3组:A组21例,为一期切除原发灶和肝转移灶并经肝动脉和门静脉置泵化疗者;B组15例,为单纯原发灶切除并经肝动脉和门静脉置泵化疗者;C组10例,为原发灶和肝转移灶均未能切除而仅行肝动脉和门静脉置泵化疗者。用KaplanMeier法对病人的生存时间作统计分析。结果:A、B、C3组术后中位生存期分别为38、20和13个月;各组之间术后生存时间的比较均有显著统计学差异(P<0.01)。结论:结直肠癌原发灶和肝转移灶一期手术切除并经肝动脉和门静脉置泵化疗的疗效最好;肝转移灶无法切除者能将原发灶切除并经肝动脉和门静脉置泵化疗也可取得较好的疗效;原发灶和肝转移灶未能切除而仅经肝动脉和门静脉置泵化疗的疗效相对较差。对结直肠癌同时性肝转移应采取以手术切除为主的综合措施进行积极治疗。     

Embolization of the Replaced Common Hepatic Artery Before Surgery for Pancreatic Head Cancer: Report of a Case

We report the case of a patient with pancreatic head cancer, whose replaced common hepatic artery (RCHA) arose from the superior mesenteric artery (SMA). We performed preoperative embolization of the RCHA, after which the liver blood flow was well maintained by the left gastric artery. The patient underwent a radical operation involving en bloc resection of the RCHA without any serious complications.     

复杂泡型肝包虫病MDT讨论

目的 通过MDT讨论提高复杂泡型肝包虫病治疗的效果。方法 对阿坝藏族羌族自治州人民 医院2019年6月收治的1例复杂泡型肝包虫患者在术前进行MDT讨论,进行术后治疗效果评价,并总结 MDT在复杂泡型肝包虫病治疗中的作用。结果 术前CT及MRCP检查发现肝包虫病病灶巨大,侵犯第一肝门,致左右肝管梗阻,严重黄疸,经MDT讨论术前行PTCD减黄,肝功能好转后行根治性右三肝切除术 加肝管成形及肝管空肠Roux-en-Y吻合术。患者术后恢复良好,继续阿苯达唑治疗。结论 复杂泡型肝包 虫病手术根治性切除率低,通过MDT多学科讨论可提高外科治疗的有效性及安全性。     

积极开展对胃癌肝转移的多学科团队综合治疗

胃癌肝转移（GCLM）是晚期胃癌患者死亡的主要原因。GCLM以多发性转移居多．且常伴有肝外病变．特别是腹膜转移,其中绝大多数的肝转移灶无法获得根治性切除。目前,治疗GCLM的方法主要包括根治性手术治疗、胃癌姑息性切除、转移灶消融治疗、介入治疗以及全身化疗等。根据GCLM治疗现状以及解放军总医院普通外科的临床实践,对于GCLM患者,应综合分析患者的全身状态、原发胃癌类型及肝转移程度等,以个体化治疗为原则,通过多学科团队合作,开展积极的综合治疗,选择合适的综合治疗方法。     

Surgery of the liver--past, present and future

Recent advances in hepatic surgery were reviewed, accompanying our original works, as follows. Segmental anatomy of the liver, including vascular anatomy of the caudate lobe. Typical hepatic lobectomy and radical surgery for hilar carcinoma of the liver. Interruption of the hepatic artery and the portal vein branch, and their clinical significance. Indication and results of hepatic surgery, including primary liver cancer, metastatic liver cancer and localized benign disease of the liver, such as liver cyst, hemangioma, liver abscess and hepatolithiasis. Evaluation of the functional reserve of the liver and operative risk, especially preoperative evaluation of the functional reserve of the remnant liver and long-term prognosis. Furthermore, the progress in the future was expected, mainly on artificial liver, orthotopic partial liver transplantation with donor living and super-extended hepatic resection.     

转移性肝癌的治疗理念和策略

转移性肝癌是恶性肿瘤发展的终末阶段,是导致患者死亡的主要原因,其中胃肠道是常见的原发癌部位。人们正尝试通过根治转移性肝癌或控制其发展等多种治疗策略,延长患者生存期。手术治疗、全身化疗、分子靶向治疗、射频消融术、门静脉栓塞术、肝动脉导管栓塞术是转移性肝癌的有效治疗方法,其中手术治疗是转移性肝癌可能获得治愈的有效手段。相比结肠癌肝转移癌,胃癌肝转移癌的治疗正处于探索阶段,但是随着新型有效化疗药物及化疗方案的出现、肝转移癌手术适应证的拓展以及大规模多中心临床试验循证医学证据的涌现,包括胃癌肝转移在内的转移性肝癌的治疗必将朝着一个更加规范,更为有效的方向发展。     

Hepatocellular carcinoma with a solitary adrenal metastasis and poor hepatic functional reserve: Report of a case

A 54-year-old man with a 15-year history of liver disease, was found by his family physician to have multiple tumors in the right lobe of the liver and a large right retroperitoneal tumor. He was referred and admitted to our institute where a preoperative diagnosis of liver cirrhosis complicated by hepatocellular carcinoma and probable right adrenal metastasis was made. Because his hepatic functional reserve was so poor, only resection of the right adrenal tumor with a splenectomy for hypersplenism and a cholecystectomy for the prevention of cholecystitis secondary to the scheduled transcatheter arterial embolization was performed. The patient was discharged in good clinical condition 5 weeks after surgery.     

Peliosis Hepatis in a Child with X-Linked Myotubular Myopathy Treated with Living-Donor Liver Transplant: A Case Report

BackgroundMyotubular myopathy is a rare disease sometimes accompanied by peliosis hepatis, a leading cause of fatal liver hemorrhage.Case ReportWe present a case of a 2-year-old boy with myotubular myopathy who developed liver hemorrhage because of peliosis hepatis and was successfully treated with living-donor liver transplant. The patient initially presented with fever, anemia, and liver dysfunction. A computed tomographic scan revealed hemorrhages in the liver, and the patient underwent hepatic artery embolization twice. After the second embolization, multiple peliosis hepatis cavities appeared in the left lobe of the liver that had increased in size. Therefore, the patient underwent ABO-incompatible living-donor liver transplant using a lateral segment graft from his father. The patient developed severe septic shock with an unknown focus on postoperative day 18, which resolved with antibiotic therapy. On postoperative day 62, he was discharged. Fourteen months after undergoing living-donor liver transplant, the patient showed no recurrence of peliosis hepatis.ConclusionsAlthough the long-term prognosis of peliosis hepatis due to myotubular myopathy after living-donor liver transplant remains unclear, liver transplant may be a curative treatment for patients with myotubular myopathy who have uncontrollable peliosis hepatis.