2013._肝癌综合治疗修改概述.ppt

* * * * * 更多的探索仍在全世界进行 / 检索“hepatocellular carcinoma” 结果：789项试验 检索时间：8/31/2012 针对肝癌的治疗取得进展，但仍不容乐观 肝癌综合治疗有望进一步提高患者生存获益 局部治疗间联合、局部治疗与化疗/免疫治疗的联合未显示获益 基于靶向药物的临床研究与探索全面展开 以索拉非尼为代表的靶向药物与局部治疗的联合治疗已取得良好疗效 索拉非尼联合局部的治疗策略将是HCC治疗的发展方向 Thank you for your attention * * The first human liver transplant was performed in 1963 by a surgical team led by Dr. Thomas Starzl[1] of Denver, Colorado, United States. Dr. Starzl performed several additional transplants over the next few years before the first short-term success was achieved in 1967 with the first one-year survival post transplantation. Despite the development of viable surgical techniques, liver transplantation remained experimental through the 1970s, with one year patient survival in the vicinity of 25%.[2] The introduction of ciclosporin by Sir Roy Calne markedly improved patient outcomes, and the 1980s saw recognition of liver transplantation as a standard clinical treatment for both adult and pediatric patients with appropriate indications. Liver transplantation is now performed at over one hundred centers in the USA, as well as numerous centres in Europe and elsewhere. One year patient survival is 80-85%, and outcomes continue to improve, although liver transplantation remains a formidable procedure with frequent complications. Unfortunately, the supply of liver allografts from non-living donors is far short of the number of potential recipients, a reality that has spurred the development of living donor liver transplantation. * * 手术技术的改进，如：采用肝血流阻断技术控制入肝血流，借助术中超声确定切除路线，利用手术器械(超声刀、水刀、双极电凝等)来精确止血，以减少术中失血；这些外科技术的进步使肝切除手术的死亡率和术后并发症发生率明显降低 手术适应症的相对扩大，如门静脉栓塞(PVE)技术可使一些无法手术的肝癌得以切除、降期治疗后的二期手术切除或肝移植 术中多模式的治疗。如外科切除加射频、微波等消融治疗，外科切除加冷冻治疗等。对于多灶性者，或巨大肿瘤术后有残留者，或肝硬变不能耐受更大范围肝切除者，外科加消融治疗可起到弥补和增加疗效的作用。 应用门静脉栓塞 (PVE) 诱导未来残余肝增生肥大，提高肝癌手术切除率。 目前在国际上常用的肝癌肝移植患者选择标准主要有米兰标准（Milan Criteria）和UCSF标准（UCSF Criteria） 。米兰标准是Mazzaferro等在1996年提出的，其具体内容为：①单一结节直径≤5cm；②多结节≤3个，每个直径≤3cm；③无大血管浸润及肝外转移。米兰标准是第一个得到大多数国际中心承认的肝癌肝移植的入选标准。然而目前不少意见认为米兰标准作为肝癌肝移植入选标准过于严格，