从加速康复与多学科协作探讨肝癌的全程管理

Management of hepatocellular carcinoma from the aspect of enhanced recovery and multidisciplinary support

  • 摘要: 外科技术的进步,提高了肝癌手术的精准性、安全性。但首次诊断为不可切除的肝癌患者比例仍然庞大,肝癌术后复发也较为多见,因此,延长中晚期肝癌患者生存时间成为一项日益严峻的挑战。笔者单位以提高肝癌患者5年生存率为目标,针对肝癌自然病程的特征,对可切除肝癌患者强调加速康复,提高外科疗效;对不可切除肝癌患者强调多学科协作、延长生存时间。通过反复实践,笔者单位制订了《肝切除手术加速康复·院内指南》,在缩短平均住院时间的同时加强学科间的协作。近年肝癌放疗、靶向治疗、免疫治疗均有新的突破,中晚期肝癌患者也可通过多学科协作治疗争取最佳的生存获益。笔者总结其团队肝脏外科加速康复的实践经验,回顾近年肝癌多学科协作、综合治疗进展,对肝癌的全程管理进行交流探讨。

     

    Abstract: Advances in surgical techniques have improved the precision and safety of liver surgery. However, there are still a large number of patients diagnosed unresectable at the first time and recurrence after liver surgery is universal. It is a tough challenge to prolong survival time of patients with advanced hepatocellular carcinoma (HCC). The authors′ center has made several attempts to improve 5-year survival of HCC patients. Enhanced recovery after surgery (ERAS) has been emphasized to improve surgical efficiency for patients with resectable HCC and multidisciplinary support has been emphasized to prolong survival time for unresectable HCC. Guideline for ERAS of Hepatectomy in West China Hospital of Sichuan University is conducted in the authors′ center aimed to shorten duration of hospital stay and strengthen interdisciplinary coordination after repeated clinical practice. Patients with advanced HCC can achieve survival benefits from recent breakthroughs in radiotherapy, molecular targeted therapy and immunotherapy. The authors in this article have introduced their clinical experience of ERAS in hepatic surgery, reviewed advances in multidisciplinary support and comprehensive treatment of HCC, discussed whole processing management of HCC.

     

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