巨大肝癌转化治疗1例MDT讨论

Conversion therapy of giant liver cancer:a case of MDT discussion

目的探讨多学科团队(multidisciplinary team,MDT)协作诊疗模式在肝癌转化治疗中的价值。方法回顾性分析2019年4月乐山市人民医院收治的1例初始切除高风险右肝巨大肝癌经MDT讨论、成功转化治疗后安全行肝切除手术治疗的肝癌患者的临床资料。结果患者、62岁男性,以“腹胀1+月,发现肝脏占位10 d”收入笔者所在医院,完善相关辅助检查,诊断为右肝巨大原发性肝细胞癌,因瘤体巨大无法安全行一期手术切除,经MDT讨论后,制定经肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合索拉非尼靶向治疗以缩小病灶、转化后安全行二期手术切除的治疗方案。2周期TACE联合索拉非尼靶向药物治疗后,经MDT讨论认为可安全施行手术切除,遂行荧光引导下腹腔镜肝右后叶切除术,术后病理学检查提示中分化肝细胞癌,患者于术后1周顺利恢复出院。门诊随访32个月,目前未见明显异常。结论MDT讨论能够为晚期肝癌患者制定更为个体化的治疗方案,提高晚期肝癌的转化率及可切除率,在晚期肝癌的诊治中具有重要价值。

Objective To investigate the value of multidisciplinary team(MDT)diagnosis and treatment model in the conversion therapy of liver cancer.Method The clinical data of a patient with high-risk giant liver cancer of the right liver who was admitted to People’s Hospital of Leshan in April 2019,and who was successfully conversion therapy and safely underwent hepatectomy after MDT discussion was retrospectively analyzed.Results A 62 years old male patient was admitted to our hospital with“abdominal distension for more than 1 month,and liver mass was found for 10 days”.The relevant auxiliary examinations were perfected.The patient was diagnosed as huge primary hepatocellular carcinoma in the right liver.One-stage surgical resection cannot be performed safely due to the huge tumor.After MDT discussion,transcatheter arterial chemoembolization(TACE)combined with sorafenib targeted therapy was decided to reduce the lesions,and two-stage surgical resection was performed safely after conversion therapy.After two cycles of TACE combined with sorafenib targeted drug therapy,MDT discussed the feasibility of safe surgical resection,and underwent fluorescence-guided laparoscopic right posterior lobectomy.The postoperative pathological examination revealed moderately differentiated hepatocellular carcinoma.The patient recovered and was discharged from the hospital one week later.Outpatient followed-up for 32 months showed no obvious abnormality.Conclusions MDT discussion can formulate a more individualized treatment plan,improve the conversion rate and resectable rate of advanced liver cancer,and has important value in the diagnosis and treatment of advanced liver cancer.