肝圆韧带修补受侵下腔静脉治疗肝内胆管细胞癌1例MDT讨论  

Repair of invading inferior vena cava with round ligament of liver for treatment of intrahepatic cholangiocarcinoma:a case of MDT discussion

作　　者：李靖[1,2] 蒋泽斌[1,2] 马炳强[1,2] 阎于珂 侯亚勃 柴乃俊 孟云 杨晓军[1,2] LI Jing;JIANG Zebin;MA Bingqiang;YAN Yuke;HOU Yabo;CHAI Naijun;MENG Yun;YANG Xiaojun(The Second Department of General Surgery,Gansu Provincial Hospital,Lanzhou 730000,P.R.China;Gansu Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology,Gansu Provincial Hospital,Lanzhou 730000,P.R.China;Clinical College of Gansu University of Chinese Medicine,Lanzhou 730000,P.R.China)

机构地区：[1]甘肃省人民医院普外二科,兰州730000 [2]甘肃省外科肿瘤分子诊断与精准治疗重点实验室,甘肃省人民医院,兰州730000 [3]甘肃中医药大学临床学院,兰州730000

出　　处：《中国普外基础与临床杂志》2022年第11期1445-1451,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：甘肃省卫生健康行业科研计划项目(项目编号:GSWSKY2021-060);甘肃省人民医院院内科研基金项目(项目编号:21GSSYC-3);甘肃省自然科学基金项目(项目编号:20JR10RA402)。

摘　　要：目的 总结累及下腔静脉的肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)治疗的多学科团队(multi disciplinary team,MDT)讨论。方法 回顾性分析甘肃省人民医院于2020年9月诊治的1例疑难ICC患者的临床资料,结合文献对ICC的临床特征、诊断要点、治疗决策及预后进行分析总结。结果 该患者初步诊断为肝恶性肿瘤,侵及右侧肾上腺及下腔静脉,经MDT讨论后决定行手术治疗。该患者成功实施了肝肿瘤联合右侧肾上腺和部分下腔静脉根治切除及血管重建,手术时间300 min,术中出血约600 mL。术后病理学检查结果提示符合ICC诊断,下腔静脉和肾上腺可见癌组织累及。患者术后无并发症发生,于术后2周出院,已获访半年,规律行以吉西他滨为基础联合铂类的化疗方案6期,未见肿瘤复发和转移。结论 ICC起病隐匿,侵袭性强,初步诊断可依据影像学检查结合肿瘤标志物检测确定;治疗以根治性手术为主,经MDT讨论制定包括手术策略、局部治疗及全身治疗的综合方案可改善患者预后,延长生存时间。Objective To summarize the multi disciplinary team(MDT) discussion in the treatment of intrahepatic cholangiocarcinoma(ICC) involving inferior vena cava(IVC). Method The clinical data of a difficult ICC patient diagnosed and treated in Gansu Provincial Hospital in September 2020 were analyzed retrospectively, and the clinical features, diagnosis, treatment decision and prognosis of ICC were summarized. Results The patient was initially diagnosed as liver malignant tumor, which invaded the right adrenal gland and inferior vena cava. After MDT discussion,the patient decided to undergo surgical treatment, and successfully underwent radical resection of liver tumor combined with right adrenal gland and partial inferior vena cava and vascular reconstruction. The operation lasted 300 minutes, and the intraoperative bleeding was about 600 mL. The results of postoperative pathological examination indicated that it conformed to ICC, and carcinomatous tissues involvement could be seen in inferior vena cava and adrenal gland. The patient had no complication after operation and was discharged from hospital at 2 weeks after operation. The patient had been followed up for half a year and had been regularly treated with gemcitabine combined with platinum for 6 phases. No tumor recurrence or metastasis had been found. Conclusions The onset of ICC is concealed and its invasiveness is strong.The preliminary diagnosis can be determined by imaging examination combined with detection of tumor markers. Radical surgery is the main treatment. After MDT discussion, the formulation of a comprehensive treatment plan, including surgical strategy, local treatment and systemic treatment, can improve the prognosis and prolong the survival time of patients.

关 键 词：肝内胆管细胞癌 多学科团队 诊断 治疗 

分 类 号：R735.7[医药卫生—肿瘤]