肝癌不想開刀怎麼辦？栓塞加電燒新選擇

<div class="pasteContent" style="display:inline;" _ngcontent-c32=""> <meta name="qrichtext" content="1"><meta http-equiv="Content-Type" content="text/html; charset=utf-8"><style type="text/css"> p, li { white-space: pre-wrap; } </style> <p style=" margin-top:0px; margin-left:0px; margin-right:0px; text-indent:0px;"></p><div class="pasteContent" style="display:inline;" _ngcontent-c32=""><meta charset="utf-8"><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">68歲女性洗腎患者，早年曾有B型肝炎病毒帶原，追蹤超音波時，意外發現有一顆貼近肺部的肝腫瘤，安排顯影劑電腦斷層掃描，放射科醫師判定為2.8公分的肝癌。</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br clear="none"></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">肝癌接受手術切除的復發率最低，是治療的第一優先選擇。尤其是2公分以下的早期肝癌，手術切除後5年的存活率可達80％；如果肝癌集中在肝臟的同一側，就算腫瘤數目稍多或長得較大，只要剩餘的肝臟功能尚可，仍有機會作手術根除。</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br clear="none"></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">不過，患者怕痛，家屬也擔心洗腎者較高的出血風險，雖然68歲接受手術在當今已不算年邁，聽了肝膽外科劉信誠醫師的詳細解釋，家屬討論後最終選擇電燒療法(射頻灼燒術, RFA)，經由郭淑儀個案管理師的協助，轉介到我的門診。</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br clear="none"></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">對於害怕手術，以及年紀大、疾病多，不適合手術的患者，只要肝癌單顆小於3公分(最好在2公分以下)，且在3顆以內，電燒療法是一個風險較低的替代方案。作法為經局部麻醉後，插入能產生高溫的特殊細針，將肝癌細胞「燙熟殺死」。</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br clear="none"></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">術前我再次作了超音波，評估腫瘤大小、位置，規劃入針角度，發現實際上有3.7公分大，而非電腦斷層顯示的2.8公分，若只使用單針單次灼燒，恐怕消融範圍不足，將增加復發的機會。</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br clear="none"></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">保險起見，我採取血管栓塞合併電燒的二階段療法。為什麼呢？</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br clear="none"></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">肝癌像是「釘子戶」，它會分泌血管生長因子，接上週邊的血管竊取養分，血管栓塞的原理，就是經由動脈導管，打入特殊藥劑塞住供養的小血管，讓它「斷水斷電」。</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><div class="pasteContent" style="display:inline;" _ngcontent-c32=""><meta charset="utf-8"><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">對於3~5公分的中期肝癌，先塞住供氧的小血管，可減少電燒的熱能流失而燒不乾淨；而主腫塊週邊沒怎麼「接水接電」的零星病灶，對血管栓塞的反應不佳，也可能局部復發，就能用電燒來補強，彼此剛好截長補短。</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br clear="none"></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">放射科蔣咸嘉醫師施作血管栓塞術之後，讓患者休息幾天，我接著進行射頻灼燒術，在高低兩個角度各燒灼了12分鐘，確保有足夠的燒灼範圍，將局部復發的機會降到最低。</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><img class="e-rte-image e-imginline" width="auto" height="auto" alt="截圖 2020-03-06 17.51.07.png" src="https://expert.med-net.com/upload/ArticleDetail/448/截圖 2020-03-06 17.51.07.png" style="min-width: 0px; min-height: 0px;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><div class="pasteContent" style="display:inline;" _ngcontent-c32=""><meta charset="utf-8"><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">術後1個月追蹤電腦斷層，與3個月後追蹤超音波，都顯示肝癌沒有復發，總算是鬆了一口氣，感謝大千醫院肝癌團隊的共同合作，成功完成了這例挑戰！</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br clear="none"></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><br style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">肝癌的危險因子包括B、C型肝炎病毒帶原、肝硬化，提醒有以上風險的民眾記得每3到6個月定期至肝膽腸胃科追蹤，早期發現，早期處理，大多能有不錯的治療效果。</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">----</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">網誌完整圖文：<span style="font-family: "Noto Sans TC", sans-serif; font-size: 17.82px; white-space: pre-wrap;"><a class="e-rte-anchor" href="https://ssnmessage.blogspot.com/2020/03/blog-post.html" title="https://ssnmessage.blogspot.com/2020/03/blog-post.html" target="_blank">【一分鐘胃腸肝膽筆記】肝癌不想開刀怎麼辦？栓塞加電燒新選擇</a></span></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><br></div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;">感謝各大媒體熱情報導：</div><div style=" background-color: rgb(255, 255, 255);color: rgb(51, 51, 51); font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 17.82px; font-weight: 400; text-align: start; text-indent: 0px; white-space: normal;"><div style="white-space: pre-wrap;"><span style="font-family: "Noto Sans TC", sans-serif; font-size: 17.82px;"><br></span></div><div style="white-space: pre-wrap;"><span style="font-family: "Noto Sans TC", sans-serif; font-size: 17.82px;">醫病》肝癌療法新選擇把腫瘤「斷水斷電」再電燒（</span><a href="https://news.ltn.com.tw/news/life/breakingnews/3094660?utm_medium=P" target="_blank" style="font-size: 17.82px; background-color: rgb(255, 255, 255); color: rgb(102, 153, 204);">自由時報</a><span style="font-family: "Noto Sans TC", sans-serif; font-size: 17.82px;">）</span> </div><div style="white-space: pre-wrap;">肝癌不想開刀怎麼辦？電燒療法新選項（<a href="https://udn.com/news/story/7266/4402800" target="_blank" style=" color: rgb(102, 153, 204);text-decoration: none;">聯合新聞網</a>）<br>發現肝癌怕開刀電燒療法燒死癌細胞（<a href="https://www.chinatimes.com/realtimenews/20200310003040-260405?chdtv" target="_blank" style=" color: rgb(102, 153, 204);text-decoration: none;">中時電子報</a>）<br>肝癌不想開刀怎麼辦？電燒療法新選擇（<a href="https://www.epochtimes.com/b5/20/3/10/n11929154.htm" target="_blank" style=" color: rgb(102, 153, 204);text-decoration: none;">大紀元</a>）<br>她罹肝癌卻怕開刀　醫師用這招將肝癌細胞「燙熟燒死」（<a href="https://www.setn.com/News.aspx?NewsID=704926" target="_blank" style=" color: rgb(102, 153, 204);text-decoration: none;">三立新聞網</a>）<br>肝癌不一定要開刀了！血管栓塞合併電燒療法　復發機率降最低（<a href="https://health.ettoday.net/news/1664207" target="_blank" style=" color: rgb(102, 153, 204);text-decoration: none;">ETtoday健康雲</a>）</div></div></div><br></div></div><br></div></div><br><p></p></div><style type="text/css"> p, li { white-space: pre-wrap; 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