中华肝脏外科手术学电子杂志
中華肝髒外科手術學電子雜誌
중화간장외과수술학전자잡지
CHINESE JOURNAL OF HEPATIC SURGERY(ELECTRONIC EDITION)
2014年
1期
16-20
,共5页
陈焕伟%李杰原%黄沛清%麦智广%刘洪珍
陳煥偉%李傑原%黃沛清%麥智廣%劉洪珍
진환위%리걸원%황패청%맥지엄%류홍진
癌,肝细胞%妊娠%甲胎蛋白类%超声检查%肝炎,乙型%肝切除术
癌,肝細胞%妊娠%甲胎蛋白類%超聲檢查%肝炎,乙型%肝切除術
암,간세포%임신%갑태단백류%초성검사%간염,을형%간절제술
Carcinoma,hepatocellular%Pregnancy%Alpha-fetoproteins%Ultrasonography%Hepatitis B%Hepatectomy
目的：探讨晚期妊娠合并肝细胞癌（肝癌）患者的外科治疗及疗效。方法回顾性分析2011年11月至2011年12月佛山市第一人民医院肝胆外科先后收治的3例晚期妊娠合并肝癌患者临床资料。患者年龄分别为23、33、26岁。例1因孕35周，剖宫产术后进行性皮肤、巩膜黄染3周余入院，AFP 49096μg/L；例2因孕29周+4，发现肝右叶巨大占位性病变1周入院，AFP 973μg/L；例3因孕30周+6，右上腹隐痛1个月，发现肝右叶巨大占位性病变2 d入院，AFP>1210μg/L。3例患者均孕3+个月开始产检，未行上腹部超声检查，均有乙型病毒性肝炎（乙肝）病史。患者行超声、CT或MRI检查诊断为肝癌。3例患者均签署知情同意书，符合医学伦理学规定。例1先行经皮经肝胆道引流术（PTCD）减黄，后行前入路右半肝切除+胆总管切开取癌栓术+肝左管-空肠端侧吻合术。例2入院后保守治疗2周，行剖宫产术分娩1健康女婴，遂行前入路右半肝切除+肝Ⅳ段结节切除术。例3入院后保守治疗1周，自然分娩出1健康男婴，1周后行前入路肝Ⅵ、Ⅶ、Ⅷ段切除术。结果例1术后恢复顺利，于2013年1月发现肝内多发性转移，予以经导管动脉化疗栓塞（TACE）。例2术后10 d好转出院，术后4个月复查示肝、肺多发性转移，予以索拉非尼靶向治疗联合局部射频消融治疗。例3术后发生胆漏、胆道及右膈下感染、胰尾感染坏死，经过反复抗感染、多次腹腔穿刺引流、肠内营养支持等治疗93 d后好转出院，2013年2月发现肺多发性转移。3例患者至投稿日期仍存活。结论晚期妊娠合并肝癌一旦确诊，建议保胎至32周，在挽救胎儿的同时，尽早行肝切除术。患者多为晚期肝癌，疗效差。
目的：探討晚期妊娠閤併肝細胞癌（肝癌）患者的外科治療及療效。方法迴顧性分析2011年11月至2011年12月彿山市第一人民醫院肝膽外科先後收治的3例晚期妊娠閤併肝癌患者臨床資料。患者年齡分彆為23、33、26歲。例1因孕35週，剖宮產術後進行性皮膚、鞏膜黃染3週餘入院，AFP 49096μg/L；例2因孕29週+4，髮現肝右葉巨大佔位性病變1週入院，AFP 973μg/L；例3因孕30週+6，右上腹隱痛1箇月，髮現肝右葉巨大佔位性病變2 d入院，AFP>1210μg/L。3例患者均孕3+箇月開始產檢，未行上腹部超聲檢查，均有乙型病毒性肝炎（乙肝）病史。患者行超聲、CT或MRI檢查診斷為肝癌。3例患者均籤署知情同意書，符閤醫學倫理學規定。例1先行經皮經肝膽道引流術（PTCD）減黃，後行前入路右半肝切除+膽總管切開取癌栓術+肝左管-空腸耑側吻閤術。例2入院後保守治療2週，行剖宮產術分娩1健康女嬰，遂行前入路右半肝切除+肝Ⅳ段結節切除術。例3入院後保守治療1週，自然分娩齣1健康男嬰，1週後行前入路肝Ⅵ、Ⅶ、Ⅷ段切除術。結果例1術後恢複順利，于2013年1月髮現肝內多髮性轉移，予以經導管動脈化療栓塞（TACE）。例2術後10 d好轉齣院，術後4箇月複查示肝、肺多髮性轉移，予以索拉非尼靶嚮治療聯閤跼部射頻消融治療。例3術後髮生膽漏、膽道及右膈下感染、胰尾感染壞死，經過反複抗感染、多次腹腔穿刺引流、腸內營養支持等治療93 d後好轉齣院，2013年2月髮現肺多髮性轉移。3例患者至投稿日期仍存活。結論晚期妊娠閤併肝癌一旦確診，建議保胎至32週，在輓救胎兒的同時，儘早行肝切除術。患者多為晚期肝癌，療效差。
목적：탐토만기임신합병간세포암（간암）환자적외과치료급료효。방법회고성분석2011년11월지2011년12월불산시제일인민의원간담외과선후수치적3례만기임신합병간암환자림상자료。환자년령분별위23、33、26세。례1인잉35주，부궁산술후진행성피부、공막황염3주여입원，AFP 49096μg/L；례2인잉29주+4，발현간우협거대점위성병변1주입원，AFP 973μg/L；례3인잉30주+6，우상복은통1개월，발현간우협거대점위성병변2 d입원，AFP>1210μg/L。3례환자균잉3+개월개시산검，미행상복부초성검사，균유을형병독성간염（을간）병사。환자행초성、CT혹MRI검사진단위간암。3례환자균첨서지정동의서，부합의학윤리학규정。례1선행경피경간담도인류술（PTCD）감황，후행전입로우반간절제+담총관절개취암전술+간좌관-공장단측문합술。례2입원후보수치료2주，행부궁산술분면1건강녀영，수행전입로우반간절제+간Ⅳ단결절절제술。례3입원후보수치료1주，자연분면출1건강남영，1주후행전입로간Ⅵ、Ⅶ、Ⅷ단절제술。결과례1술후회복순리，우2013년1월발현간내다발성전이，여이경도관동맥화료전새（TACE）。례2술후10 d호전출원，술후4개월복사시간、폐다발성전이，여이색랍비니파향치료연합국부사빈소융치료。례3술후발생담루、담도급우격하감염、이미감염배사，경과반복항감염、다차복강천자인류、장내영양지지등치료93 d후호전출원，2013년2월발현폐다발성전이。3례환자지투고일기잉존활。결론만기임신합병간암일단학진，건의보태지32주，재만구태인적동시，진조행간절제술。환자다위만기간암，료효차。
Objective To discuss the surgical treatment and its effects for hepatocellular carcinoma (HCC) in late pregnancy. Methods Clinical data of 3 patients with HCC in late pregnancy who were admitted in Department Hepatobiliary Surgery, the First People's Hospital of Foshan from November 2011 to December 2011 were analyzed retrospectively. The age of the patients was 23, 33 and 26 years old respectively. Case 1 with 35 weeks pregnancy was admitted to hospital for 3+weeks of progressive jaundice in skin and sclera after caesarean, and the alpha-fetoproteins (AFP) was 49 096μg/L. Case 2 with 29+4 weeks pregnancy was admitted to hospital after 1 week of ifnding a giant occupying lesion in the right lobe of liver, and the AFP was 973μg/L. Case 3 with 30+6 weeks pregnancy was admitted to hospital for 1 month of right upper quadrant abdominal dull pain after 2 d of ifnding a giant occupying lesion in the right lobe of liver, and the AFP was>1 210μg/L. The patients who had a history of viral hepatitis B began to take obstetrical examinations from 3+month of pregnancy, but not including the upper abdomen ultrasonic scan. All of them were diagnosed with HCC by ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). The informed consents of 3 patients were obtained and the ethical committee approval was received. Case 1 underwent percutaneous transhepatic cholangial drainage (PTCD) to reduce jaundice, then underwent right hemihepatectomy by anterior approach+thrombectomy through choledochotomy+left hepatic duct-jejunum end-to-side anastomosis. Case 2 delivered a healthy baby girl by caesarean after 2 weeks of conservative treatment, then underwent right hemihepatectomy by anterior approach+hepatic segmentⅣnodulectomy. Case 3 delivered a healthy baby boy naturally after 1 week of conservative treatment, then underwent segmentⅥ,Ⅶ,Ⅷhepatectomy by anterior approach. Results Case 1 recovered well after operation and was found with multiple intrahepatic metastasis in January 2013. Then transcatheter arterial chemoembolization (TACE) was performed. Case 2 was discharged from hospital with improvement 10 d after operation. Multiple hepatic and pulmonary metastasis was found 4 months after operation, and then treatments of targeted therapy of sorafenib combined with local radiofrequency ablation were given to the patient. Case 3 suffered bile leakage, bile duct and right subphrenic infection, and pancreatic tail infection and necrosis after operation and was discharged from hospital with improvement 93 d after treatments of repeated anti-infection, percutaneous peritoneal drainage, enternal nutrition support and so on. And then multiple pulmonary metastasis was found in February 2013. All the patients survived till this article was submitted. Conclusions Once the diagnosis of HCC in late pregnancy is conifrmed, the patient is suggested to keep pregnant till 32 weeks in order to save baby’s life and undergo hepatectomy as early as possible. Most of the patients are late HCC and the curative effect is poor.
