介说新语“双安周周谈”（七）｜晚期肝癌怎么样“扭转颓势”？肝内胆管癌怎么样改善疗效？“双安组合”给出答案！
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">*仅供医学专业人士阅读参考</span></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/0KlK2BUicVAIwT6lr4Fz9C8rGM4ZPHCUQjCxxxZL8kXFeQgpiagXPHKf6XiauVaBBT6c4UsHH0xUWa4yTcFIOadYg/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">众大咖带你感知真实世界临床诊疗病例！</span></span></strong></p><span style="color: black;">介说新语“双安周周谈”第七期由<strong style="color: blue;">广西医科大学<span style="color: black;">附庸</span>肿瘤医院马<span style="color: black;">也</span>龙教授</strong>担任大会主席，<strong style="color: blue;">云南省肿瘤医院黄明教授、贵州医科大学<span style="color: black;">附庸</span>肿瘤医院赵许亚教授</strong>担任主持，<strong style="color: blue;">陆军军医大学<span style="color: black;">第1</span><span style="color: black;">附庸</span>医院张艳玲教授</strong>分享题为“靶免之路，择优而行”的精彩报告，<strong style="color: blue;">海军军医大学东方肝胆外科医院王明达教授、贵州医科大学<span style="color: black;">附庸</span>肿瘤医院李前进教授</strong>分享诊治病例，<strong style="color: blue;">云南省肿瘤医院赵玲教授、遵义大学<span style="color: black;">附庸</span>医院敖劲教授、桂林市人民医院张黎教授、广西医科大学<span style="color: black;">附庸</span>肿瘤医院赵昌教授</strong><span style="color: black;">一起</span>讨论。本文总结了病例以及精彩讨论内容，以飨读者。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvRcym4LJFPkj499asQCh1N715tia0S3VyiaJy6icUtfdziawhgushrPeb4A/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">大会主席广西医科大学<span style="color: black;">附庸</span>肿瘤医院马<span style="color: black;">也</span>龙教授</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvTBWiaiaRE4U4C70FhE4A4qPFoFWq9h5PM0dRNMziaZheDnagIcFNApAQQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">大会主持云南省肿瘤医院黄明教授</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvLkA87ibNXuxSu3Qy7ibfjrlZkD07Vbnzc6pX22CicxMAhq69KnUCbmCFg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">大会主持贵州医科大学<span style="color: black;">附庸</span>肿瘤医院赵许亚教授</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><strong style="color: blue;">靶免之路，择优而行</strong></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvZNOuYL0HVicVkKZYDuykC8xWnLzVOIWUCNRTQxRTGvRU2eYat6MEkicg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">陆军军医大学<span style="color: black;">第1</span><span style="color: black;">附庸</span>医院张艳玲教授分享报告</span><strong style="color: blue;"><span style="color: black;">陆军军医大学<span style="color: black;">第1</span><span style="color: black;">附庸</span>医院张艳玲教授</span></strong><span style="color: black;">指出，肝癌系统治疗<span style="color: black;">已然</span>从化疗/靶向时代进入靶免联合治疗时代，IMbrave150<span style="color: black;">科研</span>奠定了靶免联合在晚期肝细胞癌（HCC）一线治疗的地位，AK-105-203<span style="color: black;">科研</span>则为晚期HCC带来了又一安全有效的靶免组合：<strong style="color: blue;">派安普利单抗联合安罗替尼客观缓解率（ORR）为31%，<span style="color: black;">疾患</span><span style="color: black;">掌控</span>率为82.8%，中位<span style="color: black;">没</span><span style="color: black;">发展</span><span style="color: black;">存活</span>期（PFS）为8.8个月。并且从安全性数据上来看，“双安组合”的≥3级治疗<span style="color: black;">关联</span>不良事件（TRAE）<span style="color: black;">出现</span>率<20%,严重不良事件（SAE）<span style="color: black;">出现</span>率仅6.5%，不良反应至<span style="color: black;">药品</span>治疗中断<span style="color: black;">出现</span>率仅12.9%。</strong></span><span style="color: black;">“双安组合”<span style="color: black;">做为</span>晚期HCC<span style="color: black;">病人</span>安全有效的一线新优选，强效之下，兼顾安全。晚期肝癌靶免联合时代仍有<span style="color: black;">许多</span>未满足需求，有待<span style="color: black;">更加多</span><span style="color: black;">科研</span>数据进一步探索，“双安组合”联合肝动脉插管化疗栓塞术（TACE）正在探索中。</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▌ </span></strong>病例分享（一）｜派安普利单抗联合靶向<span style="color: black;">药品</span>治疗原发性肝癌病例分享</span></strong><strong style="color: blue;"><span style="color: black;">海军</span></strong><strong style="color: blue;"><span style="color: black;">军医大学东方肝胆外科医院王明达教授</span><span style="color: black;">分享了两例原发性肝癌病例，</span></strong><span style="color: black;"><span style="color: black;">第1</span>例<span style="color: black;">病人</span>接受TACE+派安普利单抗联合靶向<span style="color: black;">药品</span>治疗之后，疗效<span style="color: black;">评定</span>为部分缓解（PR）；第二例<span style="color: black;">病人</span>一线、二线治疗效果<span style="color: black;">不良</span>，三线改为“双安组合”治疗后，疗效<span style="color: black;">评定</span>为PR，<span style="color: black;">日前</span>病情稳定。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvJKuwiaetrPnF4ob35dCAPqIMzdTQnMib3JVr7iar2JJ4aQtkbKINhJ1VA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">海军军医大学东方肝胆外科医院王明达教授</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">临床病例（一）</strong></span></strong></span></p><strong style="color: blue;"><span style="color: black;">病史简介：</span></strong><span style="color: black;"><span style="color: black;">病人</span>男，53岁，2021-08-17首次入院治疗。<span style="color: black;">病人</span>主诉中上腹<span style="color: black;">病痛</span>、闷胀不适1月余。既往慢性乙肝肝炎病史20余年，未进行规律抗病毒治疗。</span><strong style="color: blue;"><span style="color: black;">实验室<span style="color: black;">检测</span>：</span></strong><span style="color: black;">甲胎蛋白（AFP）15453 ng/mL；PIVKA-II 8966 mAU/ml。</span><strong style="color: blue;"><span style="color: black;">影像学<span style="color: black;">检测</span>：</span></strong><span style="color: black;">上腹部<span style="color: black;">加强</span>CT示右肝右后叶占位，呈多结节融合，肝静脉右后下缘支癌栓形成；胆囊结石，慢性胆囊炎。</span><strong style="color: blue;"><span style="color: black;">临床诊断：</span></strong><span style="color: black;">1.原发性肝癌（右）伴肝短静脉癌栓形成；2.慢性乙型病毒性肝炎；3.慢性结石性胆囊炎。</span><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong><span style="color: black;"><span style="color: black;">病人</span>常规<span style="color: black;">检测</span><span style="color: black;">没</span>禁忌，<span style="color: black;">按照</span>指南<span style="color: black;">举荐</span>，采用靶免联合<span style="color: black;">方法</span>：</span><span style="color: black;">1.介入治疗（2021.08、2021.<span style="color: black;">十、</span>2021.12共三次TACE）；</span><span style="color: black;">2.免疫治疗（2021.08-2021.12共四次派安普利单抗240mg静滴）；</span><span style="color: black;">3.靶向<span style="color: black;">药品</span>（自2021.09联合仑伐替尼8mg/天）；</span><span style="color: black;">4.替诺福韦抗病毒治疗。</span><strong style="color: blue;"><span style="color: black;">疗效<span style="color: black;">评定</span>：</span></strong><span style="color: black;"><span style="color: black;">病人</span>接受TACE+派安普利单抗+仑伐替尼之后，CT示肝脏肿瘤病灶几乎完全坏死，原肿瘤病灶及肝短静脉癌栓均未见活性，疗效<span style="color: black;">评定</span>为PR。AFP和PIVKA-II均下降至正常水平，至2022年1月，<span style="color: black;">病人</span>肿瘤<span style="color: black;">状况</span><span style="color: black;">掌控</span>良好。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvWkxkaGuGFx5mLEoa14GYhm8NDfeqaGwicQW1oGTPDv3MXkclvpSV4Wg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;"><span style="color: black;">病人</span>治疗前后对比</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">临床病例（二）</strong></span></strong></span></p><strong style="color: blue;"><span style="color: black;">病史简介：</span></strong><span style="color: black;"><span style="color: black;">病人</span>男，62岁，2021-10-24首次入院治疗。因“原发性肝癌”于2020-03于当地医院行右肝肿瘤切除术；2020-10<span style="color: black;">显现</span>肝内复发（右肝，多发），于当地行TACE+索拉非尼治疗400mg口服1次/日；2020.10至2021.09<span style="color: black;">疾患</span>仍有<span style="color: black;">发展</span>，肿瘤标志物进行性<span style="color: black;">上升</span>，治疗<span style="color: black;">方法</span>先后<span style="color: black;">调节</span>为卡瑞利珠单抗+阿帕替尼，后因毛细血管增生反应改为信迪利单抗三周<span style="color: black;">方法</span>，<span style="color: black;">时期</span>行2次TACE，仍<span style="color: black;">掌控</span><span style="color: black;">不良</span>。</span><strong style="color: blue;"><span style="color: black;">实验室<span style="color: black;">检测</span>：</span></strong><span style="color: black;">AFP 650 ng/mL；PIVKA-II 1394 mAU/ml。</span><strong style="color: blue;"><span style="color: black;">影像学<span style="color: black;">检测</span>：</span></strong><span style="color: black;">磁共振结果提示：肝内肿瘤多发，局部呈多结节融合，<span style="color: black;">重点</span>在右肝右后叶肝缘处；多发腰椎椎体转移可能；肝内碘油沉积<span style="color: black;">不良</span>；术区局部积液，术区未见<span style="color: black;">显著</span>复发迹象。</span><strong style="color: blue;"><span style="color: black;">治疗过程：</span></strong><span style="color: black;">既往一线二线系统治疗后<span style="color: black;">发展</span>，TACE效果<span style="color: black;">不良</span>，予以<span style="color: black;">调节</span>：</span><span style="color: black;">1.免疫治疗（2021.10-2021.02共五次派安普利单抗240mg静滴）；</span><span style="color: black;">2.靶向<span style="color: black;">药品</span>治疗（2021.10更换为安罗替尼12mg/日口服d1-14）；</span><span style="color: black;">3.腰椎放射治疗；</span><span style="color: black;">4.保肝、抗病毒治疗。</span><strong style="color: blue;"><span style="color: black;">疗效<span style="color: black;">评定</span>：</span></strong><span style="color: black;">2022.02行五周期靶免治疗后，肝内多发肿瘤不同程度的缩小、数目减少，腰椎转移肿瘤不<span style="color: black;">显著</span>，疗效<span style="color: black;">评定</span>为PR。<span style="color: black;">日前</span>肿瘤标志物<span style="color: black;">连续</span>下降，肝内病灶<span style="color: black;">掌控</span>良好，未见<span style="color: black;">显著</span>活动病灶，继续维持“双安”组合治疗，安全性较好，未见<span style="color: black;">显著</span>不良反应。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvq5EnVgFX1F5cTlvfd3ElG6ibmE9d02OyniaAXUeOy7YEZIiaDXibj9te1Q/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;"><span style="color: black;">病人</span>治疗前后对比</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvAI5ofHPxE8jqaSl2OnrCwsvx4gVjLuibWqjRgbJuW2Thrw4kBG3Yk4w/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;"><span style="color: black;">病人</span>治疗过程一览</span><span style="color: black;">王明达教授指出，派安普利单抗<span style="color: black;">做为</span>新一代免疫<span style="color: black;">检测</span>点<span style="color: black;">控制</span>剂，全方面升级，结构更优化，<span style="color: black;">有效</span>更安全。并且“双安组合”疗效确切，一线治疗肝细胞癌中位PFS 8.8个月数值再创新高，<span style="color: black;">同期</span>安全性<span style="color: black;">亦</span>良好，使得使<span style="color: black;">更加多</span><span style="color: black;">病人</span><span style="color: black;">连续</span>用药获益。“双安组合”<span style="color: black;">有效</span>低毒的特点在本例<span style="color: black;">病人</span>中<span style="color: black;">亦</span>得到了良好的<span style="color: black;">表现</span>。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▎</span></strong></span></strong></span><strong style="color: blue;"><span style="color: black;">专家讨论｜一</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvWLqymC8UL5JbdXVAGs9T7BayCulI3kN0xpjNQFu5P0j8NsYnBAPyrA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;">云南省肿瘤医院赵玲教授（左上）、遵义大学<span style="color: black;">附庸</span>医院敖劲教授（右上）、桂林市人民医院张黎教授（左下）、广西医科大学<span style="color: black;">附庸</span>肿瘤医院赵昌教授（右下）<span style="color: black;">一起</span>讨论</span><strong style="color: blue;"><span style="color: black;">云南省肿瘤医院赵玲教授</span></strong><span style="color: black;">指出：这两个病例的展示给予了<span style="color: black;">咱们</span>临床<span style="color: black;">大夫</span>在实践中应用“双安组合”<span style="color: black;">更加多</span>的<span style="color: black;">自信心</span>。<span style="color: black;">第1</span>例<span style="color: black;">病人</span>派安普利单抗联合靶向治疗疗效良好，但<span style="color: black;">因为</span>依从性<span style="color: black;">无</span><span style="color: black;">保持</span>后续治疗，<span style="color: black;">按照</span>我个人的临床经验，该<span style="color: black;">病人</span><span style="color: black;">重点</span>停药<span style="color: black;">原由</span>还是<span style="color: black;">因为</span>仑伐替尼<span style="color: black;">导致</span>的手足<span style="color: black;">综合症</span>等不良反应以及经济<span style="color: black;">原由</span>。“双安组合”的副<span style="color: black;">功效</span>较轻，<span style="color: black;">必定</span>程度上能够<span style="color: black;">保准</span><span style="color: black;">病人</span>的依从性，从而足量、足程的用药。<span style="color: black;">亦</span><span style="color: black;">期盼</span><span style="color: black;">将来</span>在我的临床实践<span style="color: black;">其中</span>能够<span style="color: black;">累积</span><span style="color: black;">更加多</span>“双安组合”的应用经验。</span><strong style="color: blue;"><span style="color: black;">遵义大学<span style="color: black;">附庸</span>医院敖劲教授</span></strong><span style="color: black;"><span style="color: black;">暗示</span>：靶免联合局部治疗的模式<span style="color: black;">日前</span>在晚期肝癌中的应用价值<span style="color: black;">已然</span>得到了<span style="color: black;">知道</span>。我在临床中<span style="color: black;">亦</span>经常会遇到跟王明达教授分享的<span style="color: black;">第1</span>例病例<span style="color: black;">状况</span><span style="color: black;">类似</span>的<span style="color: black;">病人</span>——肿瘤体积并不大但合并有肝短静脉侵犯，尽管治疗后影像学上得到良好缓解，但病情再次<span style="color: black;">发展</span>或转移的速度较快。在<span style="color: black;">这儿</span><span style="color: black;">亦</span>想请教王明达教授合并有肝静脉侵犯的肝癌<span style="color: black;">病人</span>接受全身和/或局部治疗后取得<span style="color: black;">必定</span><span style="color: black;">掌控</span>效果，应该<span style="color: black;">怎样</span>制定外科手术的应用<span style="color: black;">机会</span>？</span><strong style="color: blue;"><span style="color: black;">王明达教授</span></strong><span style="color: black;">谈道：<span style="color: black;">思虑</span>到<span style="color: black;">第1</span>例<span style="color: black;">病人</span>初始治疗时有肝静脉癌栓形成，手术治疗效果并<span style="color: black;">不睬</span>想，<span style="color: black;">因此呢</span>先行全身治疗联合局部治疗，待癌栓失去活性后再<span style="color: black;">思虑</span>手术治疗。从外科治疗的<span style="color: black;">方向</span>来看，只要<span style="color: black;">病人</span>符合手术切除的<span style="color: black;">前提</span>，都应该尽快接受外科治疗，不要<span style="color: black;">错失</span>手术窗口期。</span><strong style="color: blue;"><span style="color: black;">桂林市人民医院张黎教授</span></strong><span style="color: black;">点评：晚期肝癌术前新辅助治疗能够起到降期<span style="color: black;">功效</span>，<span style="color: black;">乃至</span>将不可切除转化为可切除。<span style="color: black;">第1</span>例<span style="color: black;">病人</span>合并有肝短静脉癌栓形成，容易<span style="color: black;">显现</span>肺转移，<span style="color: black;">经过</span>派安普利单抗联合靶向治疗，<span style="color: black;">病人</span>肿瘤得到良好<span style="color: black;">掌控</span>，此时最佳的治疗<span style="color: black;">办法</span>我<span style="color: black;">亦</span>认为<span style="color: black;">亦</span>是<span style="color: black;">即时</span>手术。<span style="color: black;">咱们</span><span style="color: black;">亦</span>遇到过一个类似<span style="color: black;">状况</span>且不愿意接受手术的<span style="color: black;">病人</span>，<span style="color: black;">咱们</span><span style="color: black;">举荐</span>的治疗方式是消融，消融术后继续靶免治疗维持，<span style="color: black;">日前</span><span style="color: black;">状况</span>良好。</span><strong style="color: blue;"><span style="color: black;">广西医科大学<span style="color: black;">附庸</span>肿瘤医院赵昌教授</span></strong><span style="color: black;">谈道：“双安组合”的安全性非常良好，<span style="color: black;">因此呢</span>当<span style="color: black;">第1</span>例<span style="color: black;">病人</span><span style="color: black;">因为</span>仑伐替尼的不良反应而停药时或许<span style="color: black;">能够</span><span style="color: black;">思虑</span><span style="color: black;">运用</span>安罗替尼<span style="color: black;">做为</span>替代治疗，从而延长<span style="color: black;">病人</span>接受靶免治疗的周期，或能取得更好的疗效。晚期肝癌一线治疗<span style="color: black;">日前</span>能够<span style="color: black;">选取</span>的<span style="color: black;">药品</span><span style="color: black;">方法</span>非常多，但一线治疗<span style="color: black;">发展</span>后<span style="color: black;">因为</span>治疗<span style="color: black;">选取</span>有限，临床<span style="color: black;">大夫</span>就会尤为<span style="color: black;">小心</span>。但第二例<span style="color: black;">病人</span>三线应用“双安组合”效果依旧良好，<span style="color: black;">因此呢</span><span style="color: black;">倘若</span>将“双安组合”战线前移，或许能够起到更好的疗效。</span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▌ </span></strong>病例分享（二）｜肝内胆管癌合并梗黄的综合治疗</span></strong><strong style="color: blue;"><span style="color: black;">贵州医科大学<span style="color: black;">附庸</span>肿瘤医院李前进教授</span></strong><span style="color: black;">分享了一例肝内胆管癌合并梗黄的综合治疗病例，<span style="color: black;">病人</span>接受了“双安组合”联合局部治疗后，疗效<span style="color: black;">评定</span>为PR，且<span style="color: black;">没</span><span style="color: black;">显著</span>不良反应。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;">贵州医科大学<span style="color: black;">附庸</span>肿瘤医院李前进教授分享病例</strong></span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvjU5Y2BWqk8ql75CM6ZdibJdmZAI91TsibQYqKV6ibSB5cXOmGcdz1VfGg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><strong style="color: blue;"><span style="color: black;">病史简介：</span></strong><span style="color: black;"><span style="color: black;">病人</span>，女，59岁，因“黄疸10+天，<span style="color: black;">发掘</span>肝占位2天”就诊我科，体格<span style="color: black;">检测</span>示皮肤、巩膜<span style="color: black;">显著</span>黄染。3+年于“贵州省人民医院”行甲状癌根治性切除术。</span><strong style="color: blue;"><span style="color: black;">实验室<span style="color: black;">检测</span>：</span></strong><span style="color: black;">胆红素、转氨酶均<span style="color: black;">反常</span><span style="color: black;">上升</span>，多项肿瘤标志物呈<span style="color: black;">反常</span>水平（详见下图）。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/JjUUPEWpIguy9IzyvJE66sKVgxCdFwlvicmsHCSqkSFfcRxcqBf9FFgeV0Ox9xgj49QYbhr1CBpZHgooEjCRAQg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;"><span style="color: black;">病人</span>实验室<span style="color: black;">检测</span>结果</span><strong style="color: blue;"><span style="color: black;">影像学<span style="color: black;">检测</span>：</span></strong><span style="color: black;">上腹部CT<span style="color: black;">加强</span>扫描：1、<span style="color: black;">思虑</span>肝S4段—胆囊窝区恶性占位，肝内胆管细胞性肝癌；2、高位胆道梗阻，<span style="color: black;">思虑</span>病灶压迫<span style="color: black;">导致</span>；3、临近结肠累及可能。</span><strong style="color: blue;"><span style="color: black;">病理活检：</span></strong><span style="color: black;">2021-8-24肝占位穿刺活检：上皮源性恶性肿瘤浸润。</span><strong style="color: blue;"><span style="color: black;">临床诊断：</span></strong><span style="color: black;">肝内胆管细胞癌cT3N0M0 IIIA期；梗阻性黄疸；甲状腺癌切除术后。</span><strong style="color: blue;"><span style="color: black;">治疗经过：</span></strong><span style="color: black;">经<span style="color: black;">太多</span>学科会诊（MDT）讨论后，制定了如下治疗<span style="color: black;">方法</span>：</span><span style="color: black;">1.保肝治疗：舒肝宁注射液+异甘草酸镁注射液</span><span style="color: black;">2.减黄：2021-08-12介入下行PTCD术置管胆汁外引流</span><span style="color: black;">3.靶免联合（派安普利单抗联合安罗替尼）+介入治疗（TACE-－吉西他滨1g+顺铂40mg）</span><strong style="color: blue;"><span style="color: black;">疗效<span style="color: black;">评定</span>：</span></strong><span style="color: black;">经5周期免疫联合靶向治疗及两次介入治疗后复查上腹部<span style="color: black;">加强</span>CT提示病灶较前<span style="color: black;">显著</span>缩小，疗效<span style="color: black;">评定</span>为PR。胆红素、转氨酶水平恢复正常，且<span style="color: black;">没</span><span style="color: black;">显著</span>不良反应。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">▎</span></strong><strong style="color: blue;">专家讨论｜二</strong></span></strong></span></p><strong style="color: blue;"><span style="color: black;">云南省肿瘤医院赵玲教授</span></strong><span style="color: black;">指出：<span style="color: black;">日前</span>肝内胆管癌较肝细胞癌<span style="color: black;">来讲</span>，治疗手段还是比较有限，<span style="color: black;">重点</span>以化疗为主。该晚期肝内胆管癌<span style="color: black;">病人</span>接受“双安组合”以及局部治疗后，能够达到PR，效果属实不错。<span style="color: black;">同期</span>，<span style="color: black;">因为</span>肝内胆管癌时常<span style="color: black;">引起</span>胆管阻塞，影响<span style="color: black;">病人</span>消化功能，对<span style="color: black;">病人</span>生活质量造<span style="color: black;">成为了</span><span style="color: black;">有害</span>影响，<span style="color: black;">同期</span><span style="color: black;">亦</span>影响<span style="color: black;">病人</span>对治疗的耐受性，但本例<span style="color: black;">病人</span>接受“双安组合”治疗<span style="color: black;">不仅</span>疗效可观，对生活质量<span style="color: black;">亦</span><span style="color: black;">没</span>消极影响。该<span style="color: black;">病人</span>后续治疗<span style="color: black;">能够</span><span style="color: black;">思虑</span>行基因检测，从而<span style="color: black;">选择</span>对应的靶向<span style="color: black;">药品</span>。局部治疗的<span style="color: black;">选取</span>上，消融<span style="color: black;">危害</span><span style="color: black;">很强</span>，<span style="color: black;">能够</span><span style="color: black;">选取</span>放射性碘粒子<span style="color: black;">移植</span>术。</span><strong style="color: blue;"><span style="color: black;">遵义大学<span style="color: black;">附庸</span>医院敖劲教授</span></strong><span style="color: black;">谈道：我<span style="color: black;">亦</span>同意<span style="color: black;">能够</span>这例<span style="color: black;">病人</span><span style="color: black;">能够</span><span style="color: black;">思虑</span>行放射性碘粒子<span style="color: black;">移植</span>术。肝内胆管癌确实治疗手段<span style="color: black;">选取</span>有限，<span style="color: black;">同期</span>很难筛选出<span style="color: black;">敏锐</span>的化疗<span style="color: black;">方法</span>。在介入治疗手段的<span style="color: black;">选取</span>上，我会更倾向于肝动脉灌注化疗（HAIC），对<span style="color: black;">病人</span>生活质量的影响相对来说更小，并<span style="color: black;">能够</span>起到局部<span style="color: black;">掌控</span>的<span style="color: black;">功效</span>。</span><strong style="color: blue;"><span style="color: black;">桂林市人民医院张黎教授</span></strong><span style="color: black;">点评：肝内胆管癌<span style="color: black;">病人</span>的治疗确实比较棘手，本例<span style="color: black;">病人</span>的治疗效果给人以眼前一亮的感觉，治疗效果如此之好，“双安组合”的“功劳”占了绝大部分。<span style="color: black;">意见</span>这例<span style="color: black;">病人</span>后续治疗行基因检测，以期<span style="color: black;">发掘</span><span style="color: black;">关联</span>基因靶点突变，从而<span style="color: black;">运用</span>对应靶向<span style="color: black;">药品</span>，<span style="color: black;">同期</span>该<span style="color: black;">病人</span>还<span style="color: black;">能够</span><span style="color: black;">思虑</span>加上HAIC治疗<span style="color: black;">或</span>消融治疗，并<span style="color: black;">评定</span>有<span style="color: black;">没</span>切除胆囊的机会，总的<span style="color: black;">来讲</span>局部治疗的<span style="color: black;">选取</span>较多。</span><strong style="color: blue;"><span style="color: black;">广西医科大学<span style="color: black;">附庸</span>肿瘤医院马<span style="color: black;">也</span>龙教授</span></strong><span style="color: black;">最后总结道：今天与会的专家来自不同科室，<span style="color: black;">包含</span>介入科、肝胆外科以及肿瘤内科，各位专家从不同<span style="color: black;">方向</span>来讨论分析中晚期肝癌以及肝内胆管癌治疗的<span style="color: black;">办法</span>。并且不同医院、不同科室都有各自<span style="color: black;">优良</span>，能够为<span style="color: black;">病人</span>个体化治疗<span style="color: black;">供给</span>最大的<span style="color: black;">帮忙</span>。<span style="color: black;">亦</span>祝愿下一期介说新语“双安周周谈”办得更好！</span><span style="color: black;">*此文仅用于向医学人士<span style="color: black;">供给</span>科学信息，不<span style="color: black;">表率</span>本平台观点</span><img src="https://mmbiz.qpic.cn/mmbiz_jpg/EjZcMyGNiatwU1yfA4ld9jQXOuzqdRngZ0VLLqgWhFc5ss9sgGEV3QsZL3Frbh51slnZGVMiay2LbYewicD2qP7VA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
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期待更新、坐等、迫不及待等。
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