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肝细胞癌微创与多学科综合诊疗——2018广州共识
Minimally-invasive and multidisciplinary comprehensive diagnosis and treatment for HCC: 2018 Guangzhou consensus
文章发布日期:2019年09月05日  来源:  作者:亚太影像引导下肿瘤微创治疗协会,中国抗癌协会肿瘤微创治疗专业委员会,亚洲肿瘤消融学会(2017)  点击次数:176次  下载次数:30次

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【摘要】: 中国绝大多数肝癌是乙型病毒性肝炎和肝硬化长期发展的结果,具有富血供、多中心起源特点,早期即可侵犯门静脉小分支并发生肝内转移。因此,肝癌发生之初即是一种局部器官及全身性疾病。为此,临床上需要采用包括局部治疗(如手术切除、射频消融、微波消融、化学消融、冷冻消融等)、器官水平治疗[如经导管动脉灌注化疗、经肝动脉化疗栓塞术(TACE)]和系统治疗(如免疫治疗、抗病毒治疗、分子靶向治疗等)在内的综合治疗方案。本共识阐述肝细胞癌微创与多学科综合诊断和治疗方法,凸显八大特点:(1)肝动脉造影、肝动脉造影CT、动脉-门静脉造影CT、碘化油CT、TACE-CT有助于发现更多子灶,精确分期;(2)TACE/消融作为早期肝癌首选治疗;(3)浸润型肝癌作为独立分型;(4)微创综合治疗转移淋巴结;(5)M (转移)分期细化用于指导个体化治疗和判断预后;(6)肝癌伴肝功能严重失代偿是肝移植候选标准;(7)提倡生物免疫、中医中药、抗病毒及社会心理治疗贯穿各期治疗方案;(8)建议开展早、中期肝癌微创介入治疗与外科手术多中心随机对照试验研究。
【Abstract】: In China,the vast majority of hepatocellular carcinoma (HCC) is the result of long-term development of hepatitis B and cirrhosis. Pathologically, HCC is characterized by rich blood supply and multicenter origin, with early invasion of small branches of portal vein and intrahepatic metastasis. Therefore, HCC is not only a local organ but also a systemic disease at the beginning of its occurrence. For this reason, in clinical treatment of HCC a comprehensive treatment scheme should be adopted, including local treatment (such as surgical resection, radiofrequency ablation, microwave ablation, chemical ablation and cryoablation et al), organ-level therapy (such as transcatheter arterial infusion chemotherapy and transcatheter arterial chemoembolization), and systemic therapy (such as immunotherapy, antiviral therapy and molecular targeted therapy et al). This consensus sets forth the minimally-invasive and multidisciplinary comprehensive diagnosis and treatment of HCC, focusing on the following eight aspects: (1) hepatic arteriography, hepatic arteriography CT(CTHA), arterioportal angiography CT (CTAP), lipiodol CT (Lp-CT), TACE-CT, which are helpful in finding the lesion and making precise staging; (2) TACE/ablation should be used as the first choice of treatment for early stage or small HCC; (3) infiltrating HCC should be regarded as an independent type; (4) minimally-invasive comprehensive treatment of metastatic lymph nodes; (5) multi-level subdivision of M-staging used for guiding individual treatment and predicting prognosis; (6) HCC with severe hepatic decompensation is a candidate criterion for liver transplantation; (7) promotion of bio-immunotherapy, traditional Chinese medicine therapy, antiviral therapy and social psychotherapy, which should be run through all stages of treatment; (8) implementation of multicenter randomized controlled trials of minimally-invasive therapy and surgery for early and middle stage HCC is recommended.
【关键字】:肝细胞癌; 微创治疗; 多学科综合治疗; 共识
【Key words】:hepatocellular carcinoma; minimally-invasive therapy; multidisciplinary comprehensive treatment; consensus
【引证本文】:Asia-Pacific Association of Image-Guided Therapy of Oncology,Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association,Asian Conference on Tumor Ablation 2017. Minimally-invasive and multidisciplinary comprehensive diagnosis and treatment for HCC: 2018 Guangzhou consensus[J]. J Clin Hepatol, 2019, 35(10): 2176-2184. (in Chinese)
亚太影像引导下肿瘤微创治疗协会,中国抗癌协会肿瘤微创治疗专业委员会,亚洲肿瘤消融学会(2017). 肝细胞癌微创与多学科综合诊疗——2018广州共识[J]. 临床肝胆病杂志, 2019, 35(10): 2176-2184.

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