原发性肝癌-培训课件.pptVIP

八、肝癌的治疗 热凝固治疗:通过微波或射频，在肿瘤局部产生高温使肿瘤凝固变性，达到治疗肝癌或肝癌减积的目的，其适应症与冷冻治疗相同。 八、肝癌的治疗 放射治疗 化学治疗 免疫治疗 中医中药治疗 九、小结 肝癌的发病率逐年提高，有年轻化的趋势。 诊断方法、治疗方法多样。 随着原发性肝癌的早期诊断、早期治疗和肝脏外科的发展，肝癌的总体治疗效果显著提高。 以针对患者的个体化综合治疗效果较好。 A 21-year-old man presented with a 2-month history of weight loss, night sweats and early satiety. Physical exam revealed hepatomegaly, shown on this caudal view of the upper abdomen.????? The abdominal scout film shows the size of the liver, predominantly a markedly enlarged right lobe The CT scan shows a 20X15cm right lobe mass. There was no evidence of extrahepatic tumor on the abdominal CT, and CT of the chest and bone scan were both normal.?Core needle biopsy of the mass showed non-fibrolamellar hepatocellular carcinoma. Upper endoscopy and colonoscopy were normal. Bilirubin was 0.7 and liver enzymes were normal. Hepatitis serologies were normal. Alphafetoprotein was over 230,000.?????? Magnetic resonance angiogram showed no anomalous left or right hepatic arteries The patient was taken to the operating room for exploration and possible right hepatic lobectomy.????? A right subcostal (Kocher) incision was made first, exposing the bulging right lobe. Exploration showed no evidence of metastatic disease The chevron incision was completed, and the lower flap tacked down to lower abdominal skin.??? The hepatoduodenal ligament (surgeons left index finger in foramen of Winslow) was palpated, and there was no significant adenopathy The xiphoid extension was completed.? A self-retaining retractor was placed.? The periphery of the right lobe was mobilized by dividing adhesions to the transverse mesocolon.????? With the right lobe elevated, the porta hepatis was exposed.?? The gastrohepatic omentum was divided, isolating the hepatoduodenal ligament containing hepatic artery, common bile duct and portal vein. The gallbladder was removed.??? Intraoperative ultrasound was performed, revealing no evidence of disease in the left lobe.??????? The hepatic artery wa