CC-nhan-yk38

HCC và 8 phương án điều trị (khoa u gan BVCR có đủ các PP này).

1. TACE (Transcatheter arterial chemoembolization).

2. RFA (Đốt bằng sóng cao tần, dùng cho u < 2cm).

3. Laser ablation.

4. Liver transplantation

5. Percutaneous ethanol injection (PEI)

6. Combined PEI and TACE

7. Portal Vein Embolization (PVE)

8. Open

 

 

Bệnh án của Lê Trọng Nhân, YK38. Xem

  1. TACE (Transcatheter arterial chemoembolization: gây thuyên tắc bằng dầu + spongel+ hóa trị chống ung thư trong cùng dịch bơm) has most widely been applied to hepatocellular carcinoma (HCC) for patients who are not eligible for surgery. TACE has been shown to increase survival in patients with intermediate HCC by BCLC criteria. It has also been used as an alternative to surgery for resectable early stage HCC and in patients with regional recurrence of the tumor after previous resection. TACE may also be used to downstage HCC in patients who exceed the Milan criteria for liver transplantation. Other treated malignancies include neuroendocrine tumors, ocular melanoma, cholangiocarcinoma, and sarcoma. Transcatheter arterial chemoembolization plays a palliative role in patients with metastatic colon carcinoma. There is a possible benefit for liver-dominant metastases from other primary malignancies.
  2. RFA (Đốt bằng sóng cao tần, dùng cho u < 2cm) is generally indicated for small tumors within the liver and can be applied with minimal side effects. Radiofrequency ablation can be used alone or in conjunction with liver resection. Sometimes when patients have multiple tumors, some of the tumors may be surgically removed while the remaining disease is treated with RFA.
  3. Laser ablation (LA) represents one of currently available loco-ablative techniques: light is delivered via flexible quartz fibers of diameter from 300 to 600μm inserted into tumor lesion through either fine needles (21g Chiba needles) or large-bore catheters. The thermal destruction of tissue is achieved through conversion of absorbed light (usually infrared) into heat.
  4. Liver transplantation to replace the diseased liver with a cadaveric liver or a living donor graft has historically low survival rates (20%-36%). During 1996–2001 the rate had improved to 61.1%, likely related to adoption of the Milan criteria at US transplantation centers. Expanded Shanghai criteria in China resulted in overall survival and disease-free survival rates similar to the Milan criteria.[31] Studies from the late 2000 obtained higher survival rates ranging from 67% to 91%.[32] If the liver tumor has metastasized, the immuno-suppressant post-transplant drugs decrease the chance of survival.
  5. Percutaneous ethanol injection (PEI) well tolerated, high RR in small (<3 cm) solitary tumors; as of 2005, no randomized trial comparing resection to percutaneous treatments; recurrence rates similar to those for postresection. However a comparative study found that local therapy can achieve a 5-year survival rate of around 60% for patients with small HCC.
  6. Combined PEI and TACE can be used for tumors larger than 4 cm in diameter, although some Italian groups have had success with larger tumours using TACE alone.
  7. Portal Vein Embolization (PVE): Using a percutaneous transhepatic approach, an interventional radiologist embolizes the portal vein supplying the side of the liver with the tumor. Compensatory hypertrophy of the surviving lobe can qualify the patient for resection. This procedure can also serve as a bridge to transplant.
  8. Open.

 

Đăng bởi: ycantho - Ngày đăng: 02/11/2017
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