大腸癌肝轉移!奇美醫腹腔鏡大腸手術、肝臟手術合併電燒灼術 提升存活率!
2023-03-28 記者 蘇旋/報導
64歲阿明,無慢性疾病,因腹脹至診所就醫,超音波意外發現肝臟腫瘤,轉往到奇美醫學中心胃腸肝膽科門診就醫,醫師檢查發現阿明為大腸癌第四期併肝臟轉移三顆腫瘤。
因部分腫瘤體積較小又位於肝臟深處,若直接採取手術恐犧牲較多肝臟組織,大腸直腸癌團隊討論後,先安排阿明接受化學及標靶治療6次,追蹤影像確定腫瘤穩定後,同時施行腹腔鏡大腸直腸手術、肝臟腫瘤切除(圖一)以及電燒灼術(圖二)。阿明手術後恢復順利,並且完成後續化學及標靶治療,目前追蹤三年,無腫瘤復發現象。
55歲男性阿華,腹脹及上腹疼痛持續一個月,至奇美醫學中心急診就醫,醫師診察後發現為乙狀結腸腫瘤併多處肝臟轉移。
經大腸直腸癌團隊討論,阿華的肝臟一共有八顆轉移性腫瘤(圖三),安排化學及標靶治療7次,追蹤影像確認腫瘤穩定後,同時施行腹腔鏡大腸切除及肝臟腫瘤切除,並且對較深的肝臟腫瘤施行腹腔鏡電燒灼術(圖四)。阿華術後恢復順利並完成後續治療,目前門診追蹤兩年,無腫瘤復發。
奇美醫學中心一般及消化系外科主治醫師王家豪說明:近年來,大腸直腸癌發生及死亡人數呈快速增加趨勢,居所有癌症發生率及死亡率的前三名。民國95年發生人數首次超越肝癌,成為我國癌症發生人數最多的癌症。診斷大腸直腸癌時期,接近2成病人為第四期,主要以肝臟、肺臟轉移居多,而病人接受根除性治療會有較好的治癒及存活率機會。因此,如何在這些病人進行有效控制腫瘤最為重要。
隨著化學及標靶治療的進步發展,許多第四期大腸直腸癌病人病情也得到控制,讓外科醫師有機會可以將腫瘤完全切除,也因此提高病人存活機會並改善其生活品質。
然而,肝臟轉移腫瘤往往為多顆,並且會散布在肝臟雙側,有些腫瘤還可能在肝臟較深處,使得肝臟手術的困難度高,可能需要犧牲的肝臟體積也較多。倘若剩餘肝臟功能較差,這些病人常常無法再接受後續的化學及標靶治療。
奇美醫學中心一般及消化系外科主治醫師王家豪指出:近年來微創肝臟手術進步且普及,也讓許多病人於手術後恢復更快並減少術後併發症。目前奇美醫學中心微創手術在肝臟腫瘤切除的比例逐年上升,比例高達9成左右。
近五年來,奇美醫學中心一般及消化系外科已為大腸直腸癌肝臟轉移病人執行數十例腹腔鏡肝臟腫瘤電燒灼術。不僅提供更微創,減少肝臟實質受損的方式,也提高腫瘤治癒的機會。
奇美醫學中心一般及消化系外科主治醫師王家豪表示:轉移性肝臟腫瘤常常以多顆,且一些腫瘤散布在肝臟深處,全數以手術切除處置會導致肝臟體積減少,可能導致術後肝臟衰竭機率增加,並且造成病人無法完成後續的化學及標靶治療。
奇美醫學中心一般及消化系外科主治醫師王家豪強調:經過奇美醫學中心介入性放射科醫師教導及術中的指導,科內醫師對術中肝臟腫瘤電燒灼方式已有一定經驗並且可以獨立完成。目前已經有46位病患受惠,電燒灼腫瘤總數超過100顆。
同時以腹腔鏡大腸直腸手術、肝臟切除以及電燒灼肝臟深部腫瘤,已成為一般及消化系外科常規施行的手術,長期追蹤也發現與全數手術切除的病人效果相當,可謂大腸直腸癌第四期病人的福音。
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