Talk the surgical operation treatment of liver cancer

The liver cell cancer(brief name liver cancer) is one of the cancer that the whole world likes hair, annually there are around 500,000 in whole world add a patient.Before this region and African Sahara Desert of disease at Southeast Asia with south more is familiar, but in recent years in the west, this disease also has augmentative trend.The liver cancer is a very malignant cancer, its treatment is very difficult, appear death from the symptom, general only have for 4~6 months.

The liver cancer cures an available method currently very many, generally think that onlying have a surgical operation treatment(include liver excision and liver transplantation) can provide healing opportunity to parts of patients.But the surgical operation excision of liver cancer must face of the difficulty include:(1)The liver cancer is deliver in a male ripe age layer(60 －s be 70 years old) (2)so much, the patient often merges cirrhosis, chronic hepatitis and its merger disease(such as the swollen and big function Kang of the esophagus varix, spleen enter, liver function and reborn the ability be damaged),(3) liver blood circulation abundant, dissect structure complications and variation big,(4) the liver has an important physiology function and after operation liver function happens to crock up usually for can't go against of,(5) the cell of liver cancer contains the temperament that the blood vessel encroach upon(include a vein and liver vein), with the result that easy occurrence inside liver and transfer (6)of the liver outside delitescence, in the focus of new liver cancer inside the liver(chronic hepatitis, cirrhosis) of disease have keep on the possibility of occurrence.

When the patient of liver cancer diagnose invite only 15 － 20% was in keeping with to have an operation excision.Expel the patient accepts to cut off to cure a familiar factor to include:(1)The tumor has already had liver to outside transfer;(2)Door vein 2 have tumor to bolt son;(3)The liver function's severity isn't whole and including to have obvious stomach water can't use a diuretic improvement;(4)Patient the general physique condition be obviously not quite right.The cirrhosis isn't the exclusion factor that the surgical operation cut off.Tumor size, number, close by dirty machine infringe upon, the tumor has already had blowout etc., say alone to isn't the decision factor of surgical operation adaption.If patient the liver function be good, the expectation can accept the liver of big scope to cut off, and two leaf focuses then still can do excision of cure for good sex.

The preoperative check includes routine chest X light a check, the belly ultra sound, belly computer breaks layer and liver artery blood vessel to photograph etc., the Ci flaps to build a shadow check to then see diagnosis to need to be do just.The laboratory check includes routine sex blood cell to count, liver function check, Ning blood function, and the indigo green(ICG) is detained a rate for 15 minutes etc..These the check can help surgery a doctor to decide the patient of liver cancer as a result whether suit surgical operation and surgical operation in keeping with adoption of Shu type.As for the preoperative slice organization diagnoses at greatly parts of patients have no it necessity.

The method that the surgical operation cut off, have widespread some consensuseses in recent years drive surgery doctor adopt:(1)Cut off the tumor has to take to have an enough safe edge;(safe edge>1 cm)(2)As far as possible adopt to conform to excision of dissect the structure in the safe scope;(3)Blood transfusion while as far as possible avoiding surgical operation;(4)For the sake of decrease tumor surgical operation in move causable blood to go dissemination because of pull, pull to ligature to schedule to a door of cut off the area possibly for vein cent before moving liver;(5)As far as possible avoid surgical operation in break because of the tumor cause by operation.The recent years is because of the development of medical treatment instrument, like the usage of ultra sound, ultra sound ground liver machine(CUSA) in the surgical operation, widespread promoted the excision rate of surgical operation and lower its death rate.Currently surgical operation's expecting the death rate report to lie is 5.0%s at 1.2% ～s and the death reason of the most is to after operation take place liver function to crock up.Some medical centers include Japanese University of Tokyo, University of Hong Kong Mary a hospital etc., its surgical operation expect the death rate can reach to 0%.

The recent years cultural heritage reports that the patient of liver cancer in each medical center cut off five years are behind and the livability lies between 30% and 55%;Having never relapsed livability and tumor to expect for five years don't have an obvious relation.The five years livability of the empress of the small scaled liver cancer(<5 cm) Shu can reach to 50% ～s of 68%.The liver tumor cuts off behind of relapse rate and period for tumor to cut off don't be germane.

The surgical operation of liver cancer still has after cure equal Gao of relapse a rate inside liver.Liver surgery doctor at succeed of lowered liver to cut off and the liver transplant of surgical operation risk after, then hope to study how improve postoperative long-playing result further.(include to lower after operation tumor to relapse a rate and promote patient's livability)This target currently divide noodles everywhere carry on:

1.strengthen the accuracy that the surgical operation ex- image learns a check:For the sake of ability the exactitude diagnoses all tumors of a patient before Shu and avoid have inside the liver of delitescence and the liver outside transfer a focus to be not realize, some new of image method, include a computer to break the 1 F indirect sex door vein to photograph(CTAP), positive the son scan(PET scan), inject an iron Ci to flap to build to copy to wait to check, have already been use by the selectivity to decide before the Shu the number and position of tumor.

2.improve the technique of surgical operation:Include to do the excision which conforms to dissect structure, tumor excision the edge be after 1 cm, reducing liver in Shu to pull to move with reduce tumor cell blood going dissemination outside the liver in the liver of possibility, reducing to bleed quantity with avoiding Shu win or Shu as far as possible big of blood transfusion demand, have already as far as possible avoided in the surgical operation the factitiousness result in of the tumor break.This is some measure the cultural heritage have a report to the decrease Shu behind of the tumors relapse a help.

3.give the Shu lend support to sex treatment behind:Liver cancer patient Shu relapses behind, most reason for Shu behind destroy the existence blood of the focus of remaining liver cancer or the cell of the liver cancer in, have already new focus happenned because of the chronic hepatitis(include a hepatitis and C type hepatitis) virus infection.So the Shu lends support to sex treatment to also develop toward two direction researches behind.Cut off a patient in the liver, report the chemistry medicine of the manifestation whole body before the treatment can't effectively lower Shu after of the tumor relapse a rate.Investigate its reason, probably can't effectively arrive the door in the liver vein with anti-cancer medicine relevant with the cell which kills to destroy remaining liver cancer.Have owing to this, general surgery in the veteran general hospital is after gave from 1998 the patient of 28 liver cancer Shu instilled anti-cancer medicine by door vein, after Shu equally tracked after 70 months, discover with matched control comparison, the treatment set have better of do not relapse a livability.Another a valid resection lends support to sex to cure for the report of 1999 Hong Kong Chinese university behind, Shu after is relapsed a rate after give the iodine － 131 carry on a radio treatment inside the liver can effectively lower Shu by the liver artery.This treatment principle is make use of iodine － 131 of the short distance project a line bunch to kill inside liver and remenant cancer cell inside the blood vessel.

Transplant a patient who cure the liver cancer in the liver, the related report gives after show the Shu whole body the chemistry treatment can effectively lower to transplant to relapse a rate after the tumor and investigate its reason for after transplanting new liver, medicine can't the high density attain of the dead angle(door vein) has been already clean, the whole body chemistry medicine hurl with is effectively kill a blood outside liver in of cripple remaining cancer cell.And study a manifestation in recent years, lower after the Shu the usage of the immunity depressant quantity can also lower to transplant behind relapse of tumor rate.

4.the aggressive treatment relapse sex liver cancer:The surgical operation of liver cancer relapses after cut off of patient if give appropriate treatment, can prolong the patient's survival.These treatments generally include liver artery to bolt to fill and the alcohol inject and give or get an electric shock heat to burn a treatment.The cultural heritage report points out in some livers to relapse in the patient recently dispense to cut off surgical operation again liver transplantation even, can effectively prolong time of survival of patient to even provide a healing opportunity.But in the liver cancer relapse the patient, only about 25% patients are in keeping with to once more cut off, these patient's choices include the cirrhosis ratings Child A, tumor number had better little in or equal 3, and be limited by inside one liver stanza.

The improvement looked after behind before the Shu along with the surgical operation technical progress and Shu, surgical operation treatment(include liver excision and liver transplantation) liver cancer of risk in recent years already big for lower.Prospect future, the clinical doctor must face of topic is how effectively lower the empress of the Shu of patient of the tumor relapse a rate and promote a patient a long-playing livability.On the other hand, because of liver cancer ignore is to cut off treatment or liver to transplant a treatment, its treatment result all expects with tumor don't germane, therefore in early days diagnose in early days cure be count for much.To people in general, personal if take the dangerous factor(such as B type hepatitis carrier, C type hepatitis infection, cirrhosis, drink to excess over a long period of time, there is the household history of liver cancer etc.) of occurrence of have the liver cancer, actively go to a hospital to track serum A type an embryo protein a value and accept an ultra sound check every half year, actually have it with whether understanding has the evidence of tumor occurrence or not necessity.