Complex treatment _'s treatment of hepatocarcinoma

Complex treatment _'s treatment of hepatocarcinoma
Complex treatment of hepatocarcinoma

World Chinese digests the magazine Vol. 8 of number 4 of 2000 Focus forum

Author: The king is in the country

Unit: Hepatobiliary pancreas surgery of tumour hospital of Sichuan Province Sichuan Province Chengdu 610041

Keyword: Liver tumour; Treat; Recurring; Prevent and control; Genetic treatment; Liver transplantation; Tumour is residual; The liver excises the skill

Therapeutic basic principle 1 of 1st hepatocarcinoma. A complex treatment does not have a specific treatment, various treatments including that surgery is excised yet so far because of hepatocarcinoma, not 100% effect a radical cure, for this reason must adopt the policy of complex treatment, the materials show in recent years, no matter not excise treating through various that the surgery or internal medicine department means carry on, because of use some have, radically treat desired method and make therapeutic effect improve obviously use alone, synthetically reasonable, namely" three is united " Curative effect superior to " Two is united " . And " two is united " Superior to the single treatment again. The intersection of complex treatment and change to have quantity, difference to have quality, namely 1+1 but> 2; Besides simultaneous application of different therapeutic method, in line preface pass through, employ. Complex treatment can state, clinical experience and concrete terms unit possess of skill person flexible to launch according to tumour and liver function of patient. 1. 2 treats the positive therapeutic content including several respects actively: For have jaundice, ascites, person who shifts distant place, should positive surgery ascertain and strive to make one excise; As to the thing that later period hepatocarcinoma in the one that can't excise. Should adopt the positive preface to pass through complex treatment, once tumour obviously dwindles, should strive for two issues to excise; Excise a hepatocarcinoma patient as to the operation, should focus on the postoperative prevention and cure of recuring in water, if the liver artery portal vein holds and buries the planting type to give to the medicine device (implautabledrugdeliverysystem, IDDS) in the skill Prepare against postoperative chemotherapy [3 ], or postoperative early 3wk- 4wk is preventative starts the thromboembolism chemotherapy of pulse (HepaticArterialtranscatheterChemo-Emblization emo-Emblization, HACE) [4]When. Recuring and person who isolates transformation after hepatocarcinoma is excised, it can make its 5a survival rate raise 20% more to and then excise; The absolute alcohol treatment usually needs many times to be repeated in HACE and tumour. 1. 3 preface pass through, treat mountain of cloud etal Tan [5 ], find residual cancer in the second stage of most hepatocarcinoma and sample excised, explain comprehensive to inform, treat preface pass through excise in order to eliminate incomplete necessity of cancer in time make tumour dwindle; Hepatocarcinoma excise or get involved, treat postoperative, the patient has immunological function and liver function to damage, need, protect the intersection of liver and treatment at this moment and immunization therapy, and traditional Chinese medicine support treat, preface pass through treat promptly for maximum elimination tumour, maximum save organism function again. 2 preface of hepatocarcinoma pass through, excise soup encourage You [6 ] enable the treatment that hepatocarcinoma dwindle referred to as all in recent years " Narrow the treatment " ," can't excise to excise dwindle, hepatocarcinoma" Referred to as " The preface passes through and excises " ,Preface pass through excise, include two excise with two excising, excise, mean surgery ascertain find hepatocarcinoma can't excise for the first time while being the second stage of, take various methods to make the body of tumour narrow the last persons who are excised of operation two times. Two excise, mean hepatocarcinoma that already can't excise and then person who excises surgery after HACE make tumour dwindle diagnose, if can't let big hepatocarcinoma shrink, there is not preface that can be spoken to excise to pass through, can see the therapeutic importance in earlier stage, there are a lot of therapeutic methods in earlier stage, may be the second stage of excised in earlier stage the most hopeful means while treating by some complex treatment of one pair of routes of portal vein of IDDS liver artery, but HACE whether two excise, have, affirm method of result comparatively treat, earlier stage. Treat earlier stage, can kill, become extinct most cancer cell, preface pass through pathology to excise sample observe, find 2/3 more than sample still remaining living cancer cell [5 ], indicate it after the hepatocarcinoma treatment " Revive " Danger. In addition collateral circulation of tumour after HACE is open and tumour is able to bear the forming of nature, treat, may cause serious the intersection of liver and function damage repeatedly, so whom tumour should let slip no opportunity after dwindling pass through and excise the preface. The preface passes through and excises the best opportunity and has not got unified understanding at present, but some scholars think it is suitable for that 2mo- 5mo is more anciently after complex treatment [6 ], because intermittence too long might cause remaining cancer to be detailed to revive while being thoracic, too short organism function that may be damaged has not resumed yet. The soup encourages You [6 ] to think it is the desirable target that lump can excise but still limit a leaf, the best target is that the membrane of single bag lies in greater tumour with hard right liver that changes completely. Have a few the intersection of satellite and focus around the great tumour, limited to half liver person; Or a leaf of main tumour limitation, and another leaf person who has 1- 2 small tubercles can also be tried. The preface passes through the terms excised to include: After treating in earlier stage, the tumour volume limited to a leaf dwindles by more than 50%. Or deviate from the liver door district trunk; The tumour realm is clear, can see the membrane of bag took shape in the image learnt to check before relatively treating, and reveal that it is possible to excise; AFP rotates and drops overcastly and notably; The ChildA grade of liver function, whole body is in sound condition; There is no intravenous backbone cancer bolt of station; Have not shifted in the distant place all over. Surgery it excises to be hepatocarcinoma most important expecting, smelting, treating meansing through treat, enable the loud hepatocarcinoma part change effect a radical cure into little hepatocarcinoma actively only, it equal to by hepatocarcinoma excised to it is unable make from " Do not manage " Change into " Can partly manage " Even effected a radical cure. Soup encourage the intersection of You and etal [6 ] report 55 excise a patient while being the second stage of, its 5a survival rate was up to 60 unexpectedly. 8%, 5a survival rate after nearly excising with small hepatocarcinoma is similar, fully reveal the second stage of value excised. The hepatocarcinoma patient brought the new hope in later period in what the preface passed through and can not excise for the clinical overwhelming majority to can't be excised. The 3rd hepatocarcinoma amalgamates treatment 2 of portal vein and bile duct cancer column. The mirror which deals with the portal vein cancer bolt of hepatocarcinoma of a portal vein cancer bolt makes the incidence and is up to 90%, think portal vein backbone or the first branch form cancer should not surgery excise at the bolt in the past, patient die within several months often too, good etal [7 ] Fan report after 54 hepatocarcinoma amalgamate the intersection of portal vein and backbone or the first branched cancer bolt, excise recently 1, 2, 3, 4, 5A survival rate is 61 respectively. 7% , 36. 2% , 32. 3% , 24.4% , 22.4% , 20The example is only artery sum of liver (or) The intubate chemotherapy person of portal vein is a postoperative 1, 2a survival rate is respectively 6.0% , 0. 0%, but 14 perform the operation patient die in 3mo, Yamaokaetal [8 ] report 29 1, 2 postoperative patient, 3a 52 respectively in survival rate. 2% , 23. 2% , 11. 6% . After portal vein the intersection of cancer and bolt take out, and (or) Intubate chemotherapy of portal vein. 3.2 the intersection of bile duct and the intersection of cancer and bolt deal with the intersection of liver and cell cancer amalgamate bile duct cancer bolt comparatively rare, in 1 generally its incidence. 5% - 10% , Li AiJun etal [9 ] thinks: The cancer bolt of bile duct is different from the cancer bolt of portal vein, the latter depends on the blood supply of portal vein, can still recur after removing, and the bile duct cancer bolt only excises the having illness coming on in the cooking stove and removing and continuing the hair cooking stove in the bile duct originally of liver, may achieve the goal of radically treating. Author l0cm * l0cm * 4 when being once to a left money. 0cm and end leaf 4.0cm * 3.5cm * 3.0cm hepatocarcinoma amalgamate 2 for 2 in the person in over-all charge of gallbladder. 0cm* 1. 5cm the intersection of * 1.5cm and cancer the intersection of bolt and patient carry on tumour excise and the intersection of bile duct and the intersection of tumour and bolt remove, cooperate with the intersection of liver and artery, portal vein, the intersection of biliary tract and three the intersection of route and chemotherapy while being postoperative, the patient has not had tumoured that has survived yet 15mo resumes normal work. Complex treatment hepatocarcinoma of the 4th recuring hepatocarcinoma excises the postoperative recuring rate extremely high, the effecting a radical cure excision postoperative 5a recuring rate of big hepatocarcinoma of the report of the literature [10 ] is above 80%, the high luck too of small hepatocarcinoma 40% - 60% ; Recur in the position and rely mainly on opening liver (90% The above) ; Time of recuring 9mo- 195mo. Postoperative the intersection of 1a- and 2a, for peak time of recuring, recur, might excise range, portal vein with liver cancer bolt form and many the intersection of in the center and the intersection of origin,etc. and many kinds of factor of hepatocarcinoma have something to do. Excise, recur first-selected method and most important route to raise curative effect that cancer treats and then and then. Its condition includes: Tumour is odd one or are relatively limited to recur; Liver function is normal; There is no distant place to shift, excise the skill type to excise for the part again, its result depends on recuring in the focal size and morning and evening of course of disease. Recur cancer find early, focus little, surgery the longer time have from last time, the finer the therapeutic effect is. Soup encourage You [11 ] report, recur focus at the little hepatocarcinoma, it it excises postoperative 5a to be 46 in survival rate. 5%, as big hepatocarcinoma person while and then excising, its 5a survival rate is 0, Nagasueetal [12 ] reports cancer that 69 cases of liver recur, among them after 20 are excised 1, 2, 3, 7A survival rate is 72 respectively. 2% , 44. 7% , 26.8% , 26. 8%, persons who excise again unable or unwilling,it can select by HACE for use, from absolute alcohol injection, liquid nitrogen treatments, liver artery frozen in tumours leather and (or) Portal vein regionality pour into chemotherapy and (or) Immunization therapy, but its curative effect is inferior to excising again far, the transformation focus as to isolating outside the liver, the operation can also obtain better curative effect to excise. Question 5 that should be paid attention to in 5 hepatocarcinoma complex treatment. 1 pays attention to the rational choice of therapeutic method for the first time for the first time the choice of therapeutic method will influence the patient's subsequent treatment and prognosis directly. For excising hepatocarcinoma, if first choose to get involved and treat, can increase the difficulty and dangerous excised in surgery, and may promote the diffusion of the cancer cell; May miss surgery and excise the chance such as first-selected chemotherapy, immunity or traditional Chinese medicine treatment, for not excising hepatocarcinoma, can choose to get involved and treat etc. and narrow the treatment, create condition walk pass through, excise, if liver function lose compensate, should protect liver, traditional Chinese medicine and immunization therapy, non- appropriate treating actively may cause the serious complication to even accelerate the process of dying. Firm this, should follow tumour and the intersection of liver function and state of patient at being clinical, flexible to choose best treatment, what need to emphasize is particularly, it is a key factor to determine prognosis whether could perform the operation and excise. So, there are persons who excises possibility of operation, can't give up the operation chance easily, include that be unable to excise the persons who obviously dwindle of tumour after complex treatment. 5. It pay attention to 2 function and status that excised surgery though in difficulty and risk where surgery excise is large than in hepatocarcinomas early hepatocarcinoma of later period, last hepatocarcinoma curative effects long-term too,but excise surgery in in function, status and results long-terms being treated is definite [12 hepatocarcinoma of later period, 13]. China operation of hepatocarcinoma excise and one excise and preface pass through excise and recur, ache, excise and then later period, the key excised in operation is to judge correctly whether could excise tumour as well as keep enough liver tissues, and does not can excise tumour result in causing massive haemorrhage difficult to control as well as, the operation should give consideration to effecting a radical cure, security, three basic principles of functionality while excising. At hepatocarcinoma " Can excise " With " can't excise " Judgement have,is there unified standards objective at present yet,there are getting larger quite on factors subjective. So, on the judgement of different hospital, different professional, different doctor, certain difference often exists. Especially not a surgical specialist of liver, have often expanded" can't excise " unintentionally Range,see often by " can't excise by hepatocarcinoma" that be treated be got involved at being clinical ,In fact can totally excise with the first stage of liver. Whether could excise and should consider synthetically according to tumour situation, cirrhosis intensity and organism tolerance. Hepatocarcinoma is excised " There is no forbidden zone " Concept accepting gradually,it judge so there aren't hepatocarcinoma Correspond to double cautious, can't give up, excise the chance while being the first stage of easily. 5. 3 pay attention to, treat the intersection of prevention and cure and research of complication tumour relatively loud because of hepatocarcinoma, and the patient mostly have cirrhosis backgrounds, so there must be certain complication in various methods of complex treatment, if the liver is declined and bled etc. with the upper digestive tract. Strengthen security and curative effect that the prevention and cure research of complication contributes to improving complex treatment. The subject problem that the problem existing in 6 hepatocarcinoma complex treatment exists at present is as follows, organic association and rational preface of different therapeutic method pass through and treat the arrangement in complex treatment, main therapeutic method such as surgery excising, HACE meet the appropriate grasping and prevention and cure of complication of the card, validity and toxicity against cancer medicine, the high recurring rate after excising, amalgamate the treatment which loses compensating cirrhosis and hepatocarcinoma, and the research and development in new methods of new technology such as gene therapy, liver transplantation,etc.,etc..

References:

[1]Zhang TianZe, Xu GuangWei edits. Oncology, Tianjin: The science tech publishing house of Tianjin, 1996: 1547-1598

[2]The soup encourages You and edits, modern oncology, Shanghai: The publishing house of medical university of Shanghai, 1993; 553-610

[3]The king is in the country, Liu GuangZhong, Ding FuQuan, the liver artery portal vein in the liver carcinectomy puts the clinical meaning of IDDS, China has clinical tumour, 1998; 25: 492-494

[4]Li JinQing, Zhang YaQi, Zhang WeiZhang, the value after hepatocarcinoma is excised of chemotherapy of thromboembolism, Chinese tumour magazine, 1994; 16: 387-389

[5]Tan YunShan, Hu MingHua, Gong ZiLi, the chemical medicine of liver artery pours into the discussion that thromboembolism treated back cancer and organized the residual reason, China's surgical magazine, 1992; 30: 346-348

[6]Sheng MaoXin, Ni YongWen, forgives the honour to catch and edit, hepatocarcinoma conduit treatment and preface pass through, excise progress, Nanchang: The scientific and technological publishing house of Jiangxi, 1994: 40

[7]Fan Jia, Wu ZhiQuan, the soup encourages You, liver cell cancer is amalgamated the operation of the cancer bolt of portal vein is excised and the preface result is observed. China's surgical magazine, 1999; 37: 8-11

[8]Yamaoka Y, Kumada K, Ino K.Liver resection for hepatocellular carcinoma with direct removal of tumor thrombi in the main p ortal,Vein World J surg,1992; 16:1172-1176

[9]Li AiJun, Wu Meng exceeds, the mere looks of the money, primary hepatocarcinoma accompanies the operation of the cancer bolt of bile duct to deal with 7 reports, China's ordinary surgical magazine, 1999; 14: 15-16

[10]Ding FuQuan, the king is in the country, the clinical research progress of cancer of recuring of liver, China's practical surgical magazine, 2000; 20: Wait to issue

[11]The soup encourages You, the new tendency of clinical research of primary hepatocarcinoma, China's tumour, 1992; 2: 4

[12]Nagasue N, Yukaya H, Yu C, Assessment of pattem and treatment of intrahepatic recurrence after resection of hepatocellular carci noma.Surg Gynecol obstet,1990; 171:217

[13]Liang Li builds, Jia YuChen, Xia ZhenLong, function and position of liver artery chemotherapy thromboembolism, China's practical surgical magazine, 1999; 19: 696-703
|