外科学课件整理-Liver diseases2015Sep.pptVIP

Hong Kong algorithm Italian algorithm 中国决策树-卫生部肝细胞癌诊疗规范（2011版） 根治手术 姑息手术 无法手术 中国肝癌诊疗 HCC PS 0~2 PS 3~4 血管侵犯 Child-Pugh C 无 有 全身状况 肝功能 肝外转移 Child-Pugh A/B 无 有 肿瘤数目 ·TACE ·手术切除 ·放疗 ·分子靶向治疗 ·系统化疗 1个 2~3个 ≥4个 肿瘤大小 ≤3cm ＞3cm 治疗选择 ·TACE ·手术切除 ·+局部消融 肝移植 ·手术切除 ·局部消融≤3cm ·肝移植 ·手术切除 ·TACE+消融 ·肝移植 5cm ≥5m · 支持治疗 · 肝移植 支持治疗 TACE 放疗 分子靶向治疗 系统化疗等 * Treatment -Partial hepatectomy Radical resection offers almost the only possibility of cure. Criteria of the radical resection: absence of distant metastasis or invasion of hepatic or portal veins; tumor(s) entirely encompassed by excision of segment(s) or lobe(s). * Treatment -Partial hepatectomy Indicators for a poor prognosis after resection: 50yrs Coexistence of liver diseases (cirrhosis) Vascular invasion Portal vein thrombosis Located deep inside liver intracapsular infiltration of tumor cells bilobar involvement More than one deposit of tumor * Treatment -Partial hepatectomy Prognosis: 70% recurrence in 5yrs, could be mono-center or multi-center in origin. Follow-up using US+AFP could detect relapsed tumor at early stage, and repeat resections provide favorable outcomes to some cases. In China, ~30% 5-year survival (overall); ~60% 5-year survival (early stage HCC) * Many patients die of cirrhosis (variceal bleeding, liver failure) rather than recurrence. * 中华医学杂志, 2003 , 83 (12):1053-7. Reality---concominant chronic liver diseases 肝癌 肝炎 肝硬化 Med Clin N Am 89 (2005) 371–389 N Engl J Med. 1997 Dec 11;337(24):1733-45 HCC Hepatitis Cirrhosis 15~20%在5年内发展至肝硬化 肝硬化患者的HCC年发病率约为3-6% 90%的肝癌患者伴发肝炎、肝硬化 预后 这意味着随访100例肝硬化患者5年，有可能发现15例肝癌 * * Survival over 14yrs Survival over 25yrs Long-time Survivors’ gathering Hepatobiliary Surgery Department Of The 1st Affiliated Hospital of GMU Guangxi is an epidemic area for Hapetocellular carcinoma (HCC). Overall 5-yrs-survival post-resection is about 30%. Future：robotic hepatectomy（image guided surgery） 港东医院(PYNEH) * Treatment -Liver transplantation Of theoretic advan