肝癌伴肝功能不全患者的介入治疗:策略与哲学思想

Chemoembolization for Liver Cancer Patients with Decompensate Liver Function: Strategy and Philosophy

传统观点认为,黄疸、丙氨酸转氨酶升高、低蛋白血症合并腹腔积液、脾功能亢进所致的白细胞和(或)血小板减少是肝癌伴肝功能不全患者介入治疗的禁忌证。笔者在长期实践的基础上提出肝癌伴肝功能不全患者的介入治疗策略。首先,改良肝动脉化疗栓塞方法(减量化疗栓塞),即将化疗药物减量、栓塞剂剂量不变。其次,对伴有的肝功能不全需分析其原因,如属肿瘤压迫引起的梗阻性黄疸、肿瘤引起的丙氨酸转氨酶升高,应该先治本,即直接行减量化疗栓塞,而不是先行退黄护肝治疗;对于肝硬化、低蛋白血症引起的腹腔积液、脾功能亢进引起的白细胞和(或)血小板减少,也可以先治本再治标。

Liver cancer with decompensated liver function is conventionally contraindication for chemoembolization.Liver dysfunction including jaundice , alanine aminotransferase elevation r hypoproteinemia with ascites, hypersplenism with leukocyte and/or thrombocytopenia. Based on long-term practice, this paper proposes the strategy of chemoembolization for liver cancer patients with decompensated liver function. Firstly, modify the chemoembolization method （ Dose-reduced chemo-embolization} ,which means reduce the dose of chemotherapeutic drugs and the dosage of embolic agent remains normal. Sec-ondly ,differential the causes of liver dysfunction, such as obstructive jaundice caused by tumor compression and elevated ala-nine aminotransferase caused by tumor. For patient like these, chemoembolization should be the first choice, rather than re-duce the jaundice or protect the liver function. For patients with ascites caused by hypoproteinemia, leukopenia and/or throm-bocytopenia caused by hypersplenism, the first issue is control the tumor rather than adjuvant therapy.