1例82岁大肝癌合并多器官功能不全患者的术前MDT讨论及处理  

preoperative multidisciplinary team discussion and treatment for an 82 years old patient with large hepatocellular carcinoma complicated with multiple organ dysfunction

作　　者：李浩权 蒋经柱 王在国 莫燕霞 叶振伟 陈韵壕 LI Haoquan;JIANG Jingzhu;WANG Zaiguo;MO Yanxia;YE Zhenwei;CHEN Yunhao(Department of Hepatopancreatobiliary Surgery,Dongguan People’s Hospital,Southern Medical University,Dongguan,Guangdong 523059,P.R.China)

机构地区：[1]南方医科大学附属东莞市人民医院肝胆胰外科,广东东莞523059

出　　处：《中国普外基础与临床杂志》2022年第10期1284-1288,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的 评价多学科团队(multidisciplinary team,MDT)在高龄合并多器官功能不全的大肝癌治疗决策中的作用和价值。方法 回顾性分析南方医科大学附属东莞医院收治的1例高龄合并多器官功能不全的大肝癌患者的临床病理资料。结果 患者为一82岁高龄的男性患者,合并喘息性支气管炎、长期服用激素、重度肺通气功能障碍、中等量心包积液、高血压、肝功能代偿不良。术前经10个科室进行MDT讨论并同患者及其家属充分沟通之后拟定行开腹S5、S4b段肝切除及胆囊切除术,手术过程顺利,术后第15天时康复出院,未出现并发症。出院后服用仑伐替尼并注射用胸腺法新辅助免疫治疗。目前患者生活质量良好,未见肿瘤复发或转移。结论对于高龄合并重度心肺功能障碍的大肝癌患者,其治疗风险较大;采用MDT模式,可制定出最适合患者的最优治疗方案,以确保高效准确的诊断及保证高质量的治疗过程,使患者最大限度获益。Objective To evaluate the role and value of multidisciplinary team(MDT) in the decision-making for the treatment of elderly patients with large hepatocellular carcinoma(HCC) with multiple organ dysfunction.Method The clinicopathologic data of an elderly patient with large HCC with multiple organ dysfunction admitted to Dongguan Hospital of Southern Medical University were analyzed retrospectively. Results The patient was an 82 years old male patient with asthmatic bronchitis, long-term hormone use, severe pulmonary ventilation dysfunction,moderate pericardial effusion, hypertension, and poor liver function compensation. After MDT discussion including10 departments and full communication with the patient and his families, the open hepatectomy for hepatic S5 and S4b and cholecystectomy were proposed to perform. The operation process was smooth, and the patient was discharged on the 15th day after the operation without any complications. After discharge, lenvatinib was taken and thymosin alpha for injection was injected. At present, the patient’s quality of life was better, and there was no tumor recurrence or metastasis. Conclusions For the elderly patients with large HCC with severe cardiopulmonary dysfunction, the risk of treatment is higher. By MDT mode, the optimum treatment scheme for patient could be formulated to ensure efficient and accurate diagnosis and ensure high-quality treatment process, so as to maximally benefit patient.

关 键 词：肝细胞癌 多学科团队 治疗 效果 

分 类 号：R735.7[医药卫生—肿瘤]