臨牀消化器内科 Vol.15 No.1(11)


特集名 消化器疾患とQOL
題名 肝癌の治療とQOL
発刊年月 2000年 01月
著者 金子 弘真 東邦大学医学部第二外科
【 要旨 】 肝癌の大部分は慢性肝病変を併存しているため,肝障害の程度に応じて,またその特殊な再発形式からさまざまな治療法がある.肝癌の病巣を確実にコントロールするという点では,肝切除はもっとも根治性の高い局所療法であるが,術後再発を高率に認め,高度肝障害で術後肝不全の危険因子を伴う際には肝動脈塞栓療法(TAE),経皮的エタノール注入療法(PEIT),マイクロ波凝固壊死療法(MCN)などの非切除療法でもQOLは保持される.肝癌の治療を施行するうえでは内科領域あるいは外科領域の枠をはずし,他の治療法との比較検討を加えたうえで,十分な情報提供とインフォームド・コンセントを得ることが肝癌のQOLからみた治療の基本理念と考える.
Theme Quality of Life in Gastroenterological Disorders
Title Therapeutic Strategies and Quality of Life for Hepatocellular Carcinoma
Author Hironori Kaneko Second Department of Surgery, Toho University School of Medicine
[ Summary ] Various modalities have been established for the treatment of hepatocellular carcinoma (HCC). Surgical treatment has evolved as a curative method and postoperative mortality and morbidity after liver surgery has drastically improved along with progress in diagnostic imaging and operative techniques. The prognosis and overall QOL has improved for patients with good liver function (Clinical Stage I). However, patients with liver cirrhosis are unable to tolerate surgery and have a high risk of recurrence, including multicentric occurrences.Conservative therapy, such as transcatheter arterial embolization (TAE), percutaneous ethanol injection therapy(PEIT),and micro-wave coagulo-necrotic therapy (MCN) are now commonly used as regional and minimal invasive therapies for treatment of HCC. TAE and MCN achieved especially good clinical results in cases having small HCC. Surgical resection, or a non(-) Surgicai minimal invasive approach, remains a controversial issue from the stand points of prognosis and QOL. Therapeutic strategies of various modalities for HCC should be selected for the most favorable prognosis, along with informed consent and the best QOL for each patient.
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