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題名 | Preoperative Chemoembolization for the Treatment of Hepatocellular Carcinomas Demonstrating Complicated Anatomical Relationships=對困難位置肝癌之術前栓塞 |
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作者姓名(中文) | 陳堯俐; 郭守仁; 陳守棟; 張宏基; 虞希堯; 楊力衡; 詹賜貳; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 33:4 民89.07-08 |
頁次 | 頁171-177 |
分類號 | 416.246 |
關鍵詞 | 肝癌; 經導管動脈化學栓塞法; Transcatheter arterial chemoembolization; Hepatocellular carcinoma; |
語文 | 英文(English) |
中文摘要 | 對於經肝動脈之血管栓塞方法,使用於不適合手術切除的肝癌,因其併發症少,且可延長病患之存活率,故普遍被採用。然而對於可切除的肝癌,使用術前栓塞卻有相當多的爭議。越來越多的證據顯示,此作法並無明顯減少術後復發率及延長存活率。這篇研究,我們使用術前栓塞於困難位置之肝癌,這些病人均合併不同程度之肝硬化,及腫瘤接近重要血管,這些肝癌是可切除,但危險性高,故可稱"邊界線可切除"(borderline-resectability)。術前栓塞的好處,是可縮小腫瘤,可容易保留周邊重要血管,避免術後肝衰竭。我們並不同意例行使用術前栓塞於肝癌,但對於一些"邊界線可切除"的肝癌是可以接受的。 |
英文摘要 | The effectiveness of preoperative transcatheter arterial chemoembolization (TACE) for the treatment of resectable hepatocellular carcinoma (HCC) is still open to conjecture. Some HCCs, however, locate closely to the great vessels or hilum, such a complicated anatomical relationship often rendering the decision to conduct conventional surgery equivocal. Under such conditions, the efficacy of cytoreduction by TACE can make surgical tumor resection a safer procedure, e.g., by providing free margins and enhancing the preservation of important structures. During a 3.5-year period, we used pre-operative TACE for five HCC patients with surgically compromised tumor-location anatomy, that is proximate to structures such as the middle hepatic vein (1 case), the portal vein confluence (1 case) and the right portal vein bifurcation (3 cases). The mean interval between TACE and surgery was 10.8 weeks. Apart from one inadvertent tearing of the left intrahepatic duct, the operative procedures proceeded relatively smoothly, as anticipated, incorporating left lobectomy (1 case), right posterior sectorectomy (3 cases), and atypical central segmentectomy (1 case). All patients recovered uneventfully following surgery with a mean hospital stay of 11 days. During the subsequent follow-up period, one patient died of HCC recurrence, the others remaining free of disease. In our opinion, pre-operative TACE can be reserved for patients warranting high-risk tumor resection, especially for those patients with a surgically difficult tumor location in a cirrhotic liver. |
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