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原发性肝癌中西医结合介入诊疗专家共识(试行第一版)

2019年肝癌中西医临床协作专家委员会

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原发性肝癌中西医结合介入诊疗专家共识(试行第一版)

DOI: 10.3969/j.issn.1001-5256.2022.01.010
利益冲突声明:所有作者均声明不存在利益冲突。

    通信作者:郑加生,首都医科大学附属北京佑安医院,zhengjiasheng6@163.com;杨国旺,首都医科大学附属北京中医医院,guowangyang@sina.com

Interventional expert consensus on integrated traditional Chinese and Western medicine for the diagnosis and treatment of hepatocellular carcinoma(trial editionⅠ)

  • 摘要: 本共识由国家中医药管理局重大疑难疾病-中西医临床协作项目-肝癌项目组牵头撰写,该项目建立了早期肝癌微创根治性消融和中晚期肝癌TAE/TACE序贯微创介入消融,联合中医辨证整体施治,形成了介入栓塞标记肿瘤,序贯微创局部消融及解剖模式消融术,去除影像学可见肿瘤,建立了以肝段消融术为代表的肝脏消融体系;应用中医扶正去邪提升机体免疫功能,重塑不适合肿瘤生长的微环境,去除影像学不可见的微小肿瘤,探索出了“中西医结合临床协作治疗肝癌”的整体解决方案。本共识以中医药微环境调理和微创消融相结合为特色,充分发挥中医扶正、辨证施治的整体治疗优势与微创消融精准灭活肿瘤,同时保留正常解剖结构、生理功能和免疫功能的局部治疗特点,采用整体治疗与局部消融治疗相结合,中医药调理与微创消融相结合,开创了肝癌中西医结合微创诊疗新模式。该共识的实施使BCLC A期肝癌达到了与开放性手术相同的根治性治疗效果,使以往开放式手术不能治疗的BCLC B/C期肝癌也获得了根治性效果,使肝癌治疗进入到人文化诊疗新模式,是卫生经济学效应最大化实施方案。

     

  • 图  1  肝癌诊断路径

    图  2  肝癌分期及治疗路径

    表  1  Child-Pugh分级

    指标 1分 2分 3分
    肝性脑病 1~2期 3~4期
    腹水 轻度 中度及以上
    凝血酶原时间(s) ≤14 15~17 ≥18
    血清胆红素(μmol/L) <34.2 34.2~51.3 >51.3
    血清白蛋白(g/L) ≥35 28~34 <28
    下载: 导出CSV

    表  2  PS评分标准

    级别 体力状况
    0 活动能力完全正常,与起病前活动能力无任何差异
    1 能自由走动及从事轻体力活动,包括一般家务或办公室工作,但不能从事较重的体力活动
    2 能自由走动及生活自理,但已丧失工作能力,日间不少于一半时间可以起床活动
    3 生活仅能部分自理,日间一半以上时间卧床或坐轮椅
    4 卧床不起,生活不能自理
    5 死亡
    下载: 导出CSV

    表  3  BCLC分期标准

    肿瘤分期 PS评分 肿瘤情况 Okuda分期 肝脏功能
    0 0 单发,≤2 cm 没有门静脉高压,胆红素正常
    A1 0 单发,≤5 cm 没有门静脉高压,胆红素正常
    A2 0 单发,≤5 cm 有门静脉高压,胆红素正常
    A3 0 单发,≤5 cm 有门静脉高压,胆红素不正常
    A4 0 3个,≤3 cm Ⅰ~Ⅱ Child-Pugh A-B
    B 0 单发>5 cm,或>3个 Ⅰ~Ⅱ Child-Pugh A-B
    C 1~2 侵犯血管或肝外转移 Ⅰ~Ⅱ Child-Pugh A-B
    D 3~4 任何情况 Child-Pugh C
    注:肿瘤分期A和B,所有标准都符合;C,至少一个标准,PS1~2,或侵犯血管或肝外转移;D,至少一个标准,PS3~4,或OkudaⅢ/Child-Pugh C;0为极早期肝癌,A为早期肝癌,B为中期肝癌,C为进展期肝癌,D为终末期肝癌。
    下载: 导出CSV

    表  4  常用中成药及其功能

    中成药 功能主治
    华蟾素片或华蟾素注射液 用于中、晚期肿瘤,慢性乙型肝炎等症的解毒、消肿、止痛
    复方斑蝥胶囊 用于原发性肝癌等的破血消瘀,攻毒蚀疮
    槐耳颗粒 用于正气虚弱,瘀血阻滞,原发性肝癌不宜手术和化疗者辅助治疗,扶正固本,活血消癥
    金龙胶囊 用于原发性肝癌血瘀郁结证,破瘀散结,解郁通络
    康莱特注射液 适用于不宜手术的气阴两虚、脾虚湿困型原发性肝癌,对中晚期肿瘤患者具有一定的抗恶病质和止痛作用,益气养阴,消癥散结
    艾迪注射液 用于原发性肝癌等,清热解毒,消瘀散结
    复方苦参注射液 清热利湿,凉血解毒,散结止痛,用于癌肿疼痛、出血
    康艾注射液 用于原发性肝癌,各种原因引起的白细胞低下及减少症,慢性乙型肝炎,益气扶正,增强机体免疫功能
    消癌平注射液 用于肝癌,并可配合放疗、化疗的辅助治疗,清热解毒,化痰软坚
    榄香烯注射液 逐瘀利水,合并放、化疗常规方案对肝癌、骨转移癌等恶性肿瘤可以增强疗效,降低放、化疗毒副作用,并可用于介入、腔内化疗及癌性胸腹水的治疗
    下载: 导出CSV
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