肝上皮样血管内皮瘤术后复发再治疗MDT讨论  

Discussion on MDT of recurrent retreatment after surgery for hepatic epithelioid angioendothelioma

作　　者：祝逸民 刘符生 张中林[1] 袁玉峰[1] ZHU Yimin;LIU Fusheng;ZHANG Zhonglin;YUAN Yufeng(Department of Hepatobiliary and Pancreatic Surgery,Zhongnan Hospital,Wuhan University,Wuhan 430071,P.R.China)

机构地区：[1]武汉大学中南医院肝胆胰外科,武汉430071

出　　处：《中国普外基础与临床杂志》2023年第9期1047-1053,共7页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的通过多学科协作团队(multidisciplinary team,MDT)模式讨论1例肝上皮样血管内皮瘤术后复发患者的治疗。方法对武汉大学中南医院于2021年4月收治的1例肝上皮样血管内皮瘤复发患者的MDT讨论及疾病诊治过程进行总结。结果该患者因“肝上皮样血管内皮瘤术后1年余”收入院。患者2年前体检行上腹部CT检查提示肝左外叶有一类圆形稍低密度结节影,约30 mm×22 mm大,结节周围界限清晰,肝S7段可见点状高密度影,未给予特殊处理,定期复查。1年后复查肝脏增强CT检查提示肝左外叶肿块较前增大,且肝右叶见多发结节,入院后行MRI检查见肝脏多发异常信号灶,考虑不典型血管瘤样病变(上皮样血管内皮瘤可能)。遂行腹腔镜下肝左外叶切除+右肝部分切除+肝肿瘤射频消融术,术后患者恢复良好。于术后16个月复查MRI发现肝内转移复发可能,遂再次住院,经MDT讨论后决定再次行腹腔镜下肝肿瘤射频消融术(荧光腹腔镜)+腹腔镜下肝部分切除术(荧光腹腔镜),术后患者恢复良好,随访至今已有15个月未出现复发。结论对于肝脏上皮样血管内皮瘤术后复发患者,通过MDT讨论综合制定了再手术治疗方案,这也许会给患者带来最好的预后。Objective To discuss the treatment of a patient with postoperative recurrence of hepatic epithelioid hemangioendothelioma by multidisciplinary team(MDT)model.Methods The MDT discussion and disease diagnosis and treatment process of one patient with recurrent hepatic epithelioid angioendothelioma admitted to Zhongnan Hospital of Wuhan University in April 2021 were summarized.Results The patient was admitted to the hospital for“more than one year after operation of hepatic epithelioid hemangioendothelioma”.Two years ago,the patient’s upper abdominal CT examination showed that there was a kind of round and slightly low-density nodule shadow in the left lateral lobe of the liver,which was about 30 mm×22 mm in size,and the boundary around the nodule was clear.There was a punctate high-density shadow in the S7 segment of the liver,which was not given special treatment and was reviewed regularly.One year later,the enhanced CT examination of the liver showed that the mass in the left lateral lobe of the liver was larger than before,and multiple nodules were seen in the right lobe of the liver.After admission,MRI examination showed multiple abnormal signal foci in the liver,so atypical hemangioma-like lesions(epithelioid hemangioendothelioma may be considered)were considered.Laparoscopic left lateral lobe resection+right liver lesion resection+radiofrequency ablation of liver lesion were performed in our department,and the patient recovered well after surgery.Four months after operation,MRI reexamined and found that intrahepatic metastasis might recur,so he was re-hospitalized,and after MDT discussion,it was decided to perform laparoscopic radiofrequency ablation of liver lesions(fluorescent laparoscopy)and laparoscopic partial liver resection(fluorescent laparoscopy)again.The patient recovered well after operation,and there was no recurrence after follow-up.Conclusion For patients with postoperative recurrence of hepatic epithelioid hemangioendothelioma,a comprehensive reoperation plan is made through MDT discussi

关 键 词：肝脏上皮样血管内皮瘤 术后复发 多学科协作团队 再手术切除 

分 类 号：R735.7[医药卫生—肿瘤]