Novel treatment strategy with radiofrequency ablation and surgery for pregnant patients with hepatocellular carcinoma: a case report.
Novel treatment strategy with radiofrequency ablation and surgery for pregnant patients with hepatocellular carcinoma: a case report.
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DOI：
10.1186/s40792-018-0434-3
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发表时间：
2018-05-02
影响因子：
0.8
通讯作者：
Ohsuka M
中科院分区：
文献类型：
--
作者：
Matsuo M;Furukawa K;Shimizu H;Yoshitomi H;Takayashiki T;Kuboki S;Takano S;Suzuki D;Sakai N;Kagawa S;Nojima H;Ohsuka M
妊娠期肝细胞癌（HCC）很少见，预后较差。然而，最近，切除率的增加提高了生存率。目前，在妊娠中期后可以安全地进行各种手术，并不总是需要终止妊娠。然而，手术有时会受到胎龄或患者意愿的限制。当 HCC 患者在怀孕期间拒绝手术时，我们会面临治愈性和胎儿寿命方面的具体问题。同时，之前的研究表明射频消融（RFA）可以作为手术治疗早期 HCC 的一种可能替代方案，并显示出其对晚期 HCC 良好的局部控制率。然而，目前尚无妊娠期接受 RFA 治疗 HCC 病例的报道。在此，我们介绍一名 33 岁女性的病例，她是乙型肝炎病毒携带者。由于乙型肝炎病毒携带者可能发展为肝炎或肝癌，因此对该患者进行了随访。她在怀孕 17 周时被诊断出患有 40 毫米的肝癌肿瘤。她因怀孕而拒绝手术，并想继续怀孕；因此，我们在妊娠 17 周时对她的 HCC 进行了 RFA 局部控制，并在产后进行了根治性手术。她生下了一个健康的婴儿，手术后已经存活了 6 年，没有复发。无论患者是否怀孕，手术都是治疗 HCC 的潜在方法。然而，怀孕特有的各种问题使得进行简单的手术变得困难。我们的病例表明，RFA 可以安全地在妊娠中期的妊娠患者中进行，并且 RFA 与手术相结合可以从根本上提高妊娠期 HCC 的切除率。
Hepatocellular carcinoma (HCC) during pregnancy is rare, with a poor prognosis. Recently, however, increasing resection rates have improved survival rate. Currently, various surgeries are safely performed after the second trimester and termination of pregnancy is not always necessary. However, surgery is sometimes limited by gestational age or the patient’s will. When patients with HCC refuse surgery during pregnancy, we face specific problems with respect to curability and fetal life. Meanwhile, previous studies have revealed radiofrequency ablation (RFA) as a possible alternative to surgery for the treatment of early HCC and shown its favorable local control rate for advanced HCC. However, no case of HCC treated with RFA during pregnancy has yet been reported. Here, we present the case of a 33-year-old woman, who was a hepatitis B virus carrier. The patient had been followed up because HBV carrier could develop hepatitis or HCC. And she was diagnosed with a 40-mm HCC tumor at 17 weeks of gestation. She refused surgery because she was pregnant and wanted to continue her pregnancy; therefore, we performed RFA for the local control of her HCC at 17 weeks of gestation and radical surgery at postpartum. She delivered a healthy baby and has survived without recurrence for 6 years after the surgery. Surgery is potentially a curative treatment for HCC whether the patient is pregnant or not. However, various problems unique to pregnancy make it difficult to perform a straightforward surgery. Our case revealed that RFA can be safely performed in pregnant patients during the second trimester, and the combination of RFA and surgery can radically increase the resection rate of HCC during pregnancy.