多学科联合治疗原发性巨大肝癌1例

Multi-disciplinary team treatment for a case of primary giant liver cancer

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10cm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270min,术中出血量约500mL,予以输注悬浮红细胞400mL。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12d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。

Objective The present study was to investigate the value of multi-disciplinary team (MDT) model in patient with primary giant liver cancer. Methods The MDT model was carried out for a BCLC B stage patient who admitted in the Second Affiliated Hospital of Chongqing Medical University in July 2018. The associated references were reviewed and the treatment methods were discussed about primary giant liver cancer. Results An elder man who was diagnosed as primary hepatocellular carcinoma (minor cancer) in right lobe of the liver in three years ago and took Chinese medicine orally. When the patient subsequent visited this time, the liver cancer increased about 10 cm. After discussed by MDT, the treatment method was draw up to transarterial chemoembolization (TACE) plus surgery. After received twice TACE therapies in the later 14 weeks, the tumor in right lobe had significantly shrinked and left lobe enlarged. The patient underwent laparoscopic right liver hepatectomy after the second MDT discussion in 5 months later. The patient underwent operation successfully. The operation lasted for 270 minutes, and the intraoperative blood loss was about 500 mL. The suspended red blood cells (400 mL) was infused. The patient underwent transient liver failure and recovered through hepatoprotective and symptomatic supportive treatment, and discharged on 12 days after operation. A retrospective examination of abdominal CT at 4 months postoperatively revealed a significant hyperplasia of the left lobe of the liver, and there was no sign of recurrent tumor. The patient was continue to followed up. Conclusions The patient with primary giant hepatocellular carcinoma who cannot underwent surgery at the first time can received TACE, and a few patients could be underwent radical operation later. MDT should be applied flexibly in the treatment of patients with huge hepatocellular carcinoma from beginning to end, so the best treatment plan should be carried out for patients.