I. Overview
Liver cancer is one of the common malignant tumors in China, with high mortality rate, ranking third after gastric cancer and esophageal cancer in the order of death from malignant tumors; in some rural areas, it takes second place after gastric cancer. Every year, about 110,000 people die of liver cancer in China, accounting for 45% of liver cancer deaths worldwide. As a result of relying on serum alpha-fetoprotein (AFP) testing combined with ultrasound imaging to monitor high-risk groups, liver cancer can be diagnosed at the subclinical stage and the long-term effect of early resection is particularly remarkable. Combined with active comprehensive treatment, the five-year survival rate of liver cancer has been significantly improved.
Classification of hepatocellular carcinoma
(1) Primary liver cancer: primary carcinoma of the liver is one of the common malignant tumors in China and has a high mortality rate, ranking third after stomach and esophagus in the order of death from malignant tumors.
(2) Hepatocellular carcinoma: cancer of hepatocytes in the liver lobe. Currently, HBV infection is the most important in China.
(3) Bile duct cell carcinoma: Carcinoma in the epithelial cells of the bile duct
(4) Metastatic hepatocellular carcinoma
(5) Secondary hepatocellular carcinoma
Etiology
The main etiological factors of liver cancer in China include viral hepatitis infection, aflatoxin contamination in food, and drinking water contamination in rural areas.
(1) The known hepatitis viruses are at least types A, B, C, D, E, G, etc. The relationship between viral hepatitis and liver cancer is mainly between hepatitis B and C, i.e. HBV and HCV. about 1/3 of patients with liver cancer have a history of chronic hepatitis, and the rate of HbsAg positivity is significantly higher than that of low incidence areas. Hepatitis B virus and hepatitis C virus are definitely one of the cancer-promoting factors.
(2) About 50% to 90% of patients with liver cancer have cirrhosis, and in recent years, the proportion of hepatitis C viral hepatitis developing into cirrhosis is no less than that of hepatitis B.
(3) Animal experiments have proved that aflatoxin B1, a metabolite of aflatoxin, has a strong carcinogenic effect and is present in moldy corn, peanuts and other foods, and the incidence of liver cancer is higher in areas where food is heavily contaminated with aflatoxin B1. Nitrosamines, azo mustards, alcohol, organochlorine pesticides, etc. are all suspected carcinogens.
(4) Some drinking water is often contaminated by PCBs, chloroform, etc. In recent years, blue-green algae growing in ponds have been found to be strong carcinogenic plants that can contaminate water sources. Parasitic diseases such as Toxoplasma gondii infection can stimulate bile duct epithelial proliferation, which can lead to primary bile duct cancer.
In the 1970s, China put forward the primary prevention policy of “changing water, preventing mold and preventing hepatitis”, which is still useful and has gained initial benefits, while in the world, the main measure to prevent liver cancer is hepatitis B vaccine. 1 to 2 %.
Symptoms
The onset of hepatocellular carcinoma is often insidious, and it is mostly detected by chance during the follow-up of liver disease or physical examination and screening with AFP and B-type ultrasound. At this time, patients have no symptoms and physical examination lacks signs of tumor itself, so this stage is called subclinical stage. Once the symptoms of liver cancer appear, most of the patients who come to the clinic have already entered the middle and late stage. In the middle and late stages, the clinical treatment is usually a combination of surgery, radiotherapy and traditional Chinese medicine. The clinical manifestations of different stages of liver cancer have obvious differences.
(I) Symptoms of liver cancer: Liver pain, weakness, poor nausea and emaciation are the most characteristic clinical symptoms.
Early stage symptoms: It takes about 2 years for liver cancer to develop from the first cancer cell formation to the development of conscious symptoms. During this period, patients may not have any symptoms or signs, and a few patients may experience loss of appetite, epigastric distention and weakness, etc. Some patients may have mild hepatomegaly.
Symptoms in middle and late stage: Typical symptoms and signs of liver cancer usually appear in middle and late stage, mainly including liver pain, weakness, emaciation, jaundice, ascites, etc.
1. Pain in liver area: the most common one is intermittent persistent dull pain or swelling pain.
2.Gastrointestinal symptoms: loss of appetite, indigestion, nausea, vomiting and diarrhea are easily ignored due to lack of sexual specificity.
3, weakness, wasting: systemic weakness in the late stage of a few patients can be cachexia-like.
4.Fever: generally low fever occasionally reaches 39℃ or above, with persistent fever or afternoon low fever or chills type high fever. The fever is related to the absorption of necrotic products of cancer tumor. Biliary tract infection can be complicated by cancer compression or invasion of bile duct.
5.Symptoms of metastasis: there are corresponding symptoms in the place of metastasis of tumor, which sometimes become the first symptoms when liver cancer is found. For example, metastasis to lung can cause cough and hemoptysis; pleural metastasis can cause chest pain and bloody pleural fluid; cancer embolism blocking pulmonary artery or hair branch can cause pulmonary infarction, which can suddenly cause severe respiratory difficulty and chest pain; cancer embolism blocking inferior vena cava can cause severe edema of lower limbs and even decrease of blood pressure; blocking hepatic vein can cause Budd-Chiari syndrome and lower limb edema; metastasis to bone can cause local pain or Metastasis to bone may cause local pain or pathological fracture; metastasis to spine or compression of spinal nerve may cause local pain and paraplegia; intracranial metastasis may cause corresponding localized symptoms and signs, such as intracranial hypertension may lead to brain herniation and sudden death.
6.Other systemic symptoms: endocrine or metabolic syndromes caused by metabolic abnormalities of the cancer itself or various effects of cancer tissues on the body are called concomitant cancer syndrome, which may sometimes precede the symptoms of liver cancer itself. The common ones are.
(1) Spontaneous hypoglycemia: 10-30% of patients may have this syndrome because hepatocytes can ectopically secrete insulin or insulin-like substances, or the tumor inhibits insulinase, or secretes an islet beta-cell stimulating factor, or excessive glycogen storage; it can also be caused by excessive consumption of glucose by liver cancer tissue. Severe cases can lead to coma shock and death. Proper judgment and timely symptomatic treatment can save the patient from death.
(2) Erythrocytosis: 2-10% of patients may have symptoms related to increased erythropoietin in the circulation.
(3) Other rare: there are also hyperlipidemia, hypercalcemia carcinoid syndrome, early sexual and gonadotropin secretion syndrome, cutaneous porphyria and abnormal fibrinogenemia, which may be related to the abnormal protein synthesis ectopic endocrine and porphyrin metabolism disorder of liver cancer tissue.
7.Companion cancer syndrome: The syndrome of endocrine or metabolic abnormalities caused by the abnormal metabolism of the tumor itself, which in turn affects the body, is called the syndrome of cancer. Hypoglycemia and erythrocytosis are more common, and other rare syndromes include hyperlipidemia, hypercalcemia, precocious puberty, gonadotropin secretion syndrome and carcinoid syndrome.
Jaundice: Jaundice is a common symptom of middle and late stage hepatocellular carcinoma, and diffuse hepatocellular carcinoma and cholangiocarcinoma are most prone to jaundice. Jaundice is mostly caused by bile duct obstruction due to bile duct compression or cancer invasion of bile ducts, or due to bile duct compression by enlarged metastatic lymph nodes in the liver gate. In a few cases, the growth of hepatocellular carcinoma tissues into the bile ducts and blockage of the bile ducts by the masses cause obstructive jaundice.
Hepatocellular carcinoma may invade the bile ducts in the following ways: direct infiltration of tumor into the intrahepatic bile ducts; retrograde invasion of cancer cells into veins or lymphatic vessels; invasion of tumor cells into the bile ducts along the interstices of nerve terminals. After the tumor cells enter the intrahepatic bile duct, they continue to grow and obstruct the common bile duct or the detached masses enter the extrahepatic bile ducts and cause the filling. When the tumor obstructs one side of the liver, jaundice may be accompanied by itchy skin, intermittent clay-colored stools, decreased appetite, and in a few patients, right upper abdominal cramps, chills, fever, jaundice, and in very rare cases, symptoms of severe cholangitis. It is not uncommon for patients with hepatocellular carcinoma to have obstructive jaundice, but its clinical manifestations are not special, so the clinical misdiagnosis rate is high, up to 75%. When patients with chronic liver disease develop obstructive jaundice, the possibility of hepatocellular carcinoma should be considered. Jaundice in some patients can also be due to liver function damage. Such jaundice can be partially relieved by liver-protective therapy, while jaundice due to cancer is ineffective in reducing jaundice by liver-protective therapy.
IV. Diagnosis
Diagnosis of hepatocellular carcinoma
(I) Pathological diagnosis
1.Hepatic histological examination confirms primary liver cancer
2. Histological examination of extrahepatic tissue confirms hepatocellular carcinoma
(II) Clinical diagnosis
1.If there is no other evidence of hepatocellular carcinoma, AFP convection method is positive or AFP>400mg/ml for more than four weeks by radioimmunoassay method, and active liver disease of pregnancy, embryonic tumor of gonad and metastatic hepatocellular carcinoma can be excluded
2. Those who have clear intrahepatic substantive occupying lesions on imaging examination and can exclude hepatic hemangioma and metastatic hepatocellular carcinoma and have one of the following conditions.
① AFP>20mg/ml ② typical imaging manifestations of primary hepatocellular carcinoma ③ no jaundice but significantly increased AKP or r-GT ④ clear distant metastatic lesions or bloody ascites or cancer cells found in ascites ⑤ clear positive hepatitis B markers for cirrhosis
Differential diagnosis
1.Secondary liver cancer: Compared with primary liver cancer, secondary liver cancer has slow development and milder symptoms, most of which are secondary to gastric cancer, followed by lung, colon, pancreas, breast and other cancer foci often metastasized to liver. AFP test is generally negative except for a few cases where the primary cancer in digestion is positive.
2.Cirrhosis: Liver cancer mostly occurs on the basis of cirrhosis, and it is often difficult to distinguish between the two. The differentiation lies in detailed medical history, physical examination and laboratory tests. Cirrhosis is slow to develop and recurrent, liver function damage is more significant, and positive serum alpha-fetoprotein (AFP) mostly indicates carcinoma.
3.Active liver disease: The following points can help differentiate liver cancer from active liver disease (acute and chronic hepatitis); AFP alpha-fetoprotein test and SGPT ghrelin must be tested at the same time.
4.Hepatic abscess: manifestation of fever, pain in the liver area, manifestation of inflammatory infection symptoms, leukocyte count is often elevated, percussion pain and tenderness in the liver area are obvious, left upper abdominal muscle tension, surrounding chest wall often has edema.
5. Hepatic cavernous hemangioma: This disease is a benign intrahepatic occupying lesion, which is often found by chance due to B-type ultrasound or nuclear scan. This disease is common in China. The differential diagnosis mainly relies on fetoprotein determination, B-mode ultrasound and hepatic angiography.
6.Hepatomycosis: Patients have progressive enlargement of the liver, hard texture and nodularity, most of the liver is destroyed in advanced stage, and the clinical manifestation is very similar to primary liver cancer.
Extrahepatic tumors adjacent to the liver: such as gastric cancer, high retroperitoneal tumors in the upper abdomen, adrenal, colon, pancreatic and retroperitoneal tumors, etc. are easily confused with primary liver cancer. In addition to the fact that fetoprotein is mostly negative, different medical history and clinical manifestations, especially ultrasound, CT, MRI and other imaging examinations, as well as X-ray examination of gastrointestinal tract, can make the differential diagnosis.
V. Treatment
Early treatment is the most important factor to improve the prognosis of liver cancer. Early liver cancer should be surgically resected as much as possible.
After surgery, patients belong to the postoperative recovery period. The treatment during the recovery period is also very important. Because the chances of recurrence and metastasis are very high, the residual cancer cells will metastasize to different parts of the body from time to time after surgery. Therefore, it is necessary to strengthen the consolidation after surgery to prevent recurrence and metastasis, and to treat the symptoms with Western medicine while treating the root with Chinese medicine during the recovery period. This is a combination of Chinese and Western medicine, both the symptoms and the root cause, in order to achieve very good results, otherwise the metastasis and then the treatment is relatively late.
(I) Surgical treatment
Early resection is the key to improve the survival rate, and the smaller the tumor, the higher the five-year survival rate.
The indications for surgery are
① those with clear diagnosis and estimated lesion confined to one lobe or half of the liver.
② those without obvious jaundice, ascites or distant metastasis.
③ those with still good liver function compensation and prothrombin time not less than 50%.
(iv) Those with tolerated cardiac, hepatic and renal functions. In those with normal liver function, the amount of liver resection should not exceed 70%; in those with moderate cirrhosis, it should not exceed 50%, or only the left half of the liver can be resected; in severe cirrhosis, lobectomy cannot be performed. Surgery and pathology confirm that more than 80% of hepatocellular carcinoma is combined with cirrhosis, and it is recognized that local resection instead of regular lobectomy has the same effect, while postoperative liver dysfunction is reduced and surgical mortality is also reduced. Since radical resection still has a high recurrence rate, it is advisable to review AFP and ultrasound imaging regularly after surgery to monitor recurrence.
Because of the close follow-up after radical resection, small hepatocellular carcinoma with recurrence in the “subclinical stage” is often detected, and reoperation is preferred. Although liver transplantation is a treatment for hepatocellular carcinoma and has been reported more frequently abroad, its status in the treatment of hepatocellular carcinoma has not been confirmed for a long time. For developing countries, it is still difficult to be promoted in recent years due to the source of donor and cost problems.
(B) Palliative surgery
It is suitable for larger tumors or scattered distribution or near the large blood vessel area, or combined with cirrhosis restriction and can not be resected.
(iii) Multi-modal comprehensive treatment
It is an active and effective treatment for mid-stage large hepatocellular carcinoma in recent years, sometimes transforming unresectable large hepatocellular carcinoma into resectable smaller hepatocellular carcinoma. There are various methods, generally based on the duplex approach of hepatic artery ligation plus hepatic artery cannulation chemotherapy, plus external radiation therapy as triplex, such as combined immunotherapy quadruplex. The best effect is achieved by triple combination or above. The tumor shrinkage rate of patients treated with multimodal combination therapy reached 31%, and the second-step resection rate reached 38.1% because the tumor shrank significantly. The Institute of Hepatocellular Carcinoma of Shanghai Medical University has also studied hyper-segmentation radiotherapy and guidance therapy. The combination of hyper-segmentation external radiation and hepatic artery cannulation chemotherapy is as follows: the first week intrahepatic artery catheter chemotherapy cis-chloroplatinum (CDDP) 20 mg daily for 3 days. In the second week, local external radiation to the hepatic tumor area was given at 2.5 Gy (250 rads) in the morning and afternoon for 3 days; two weeks was a course of treatment, and so on alternating weeks could be repeated for 3 to 4 courses. Guided therapy with 131I-anti-hepatocellular carcinoma ferritin antibody or anti-hepatocellular carcinoma monoclonal antibody or 131I-lipiodol intrahepatic arterial catheter injection every 1 to 2 months, with intra-arterial CDDP 20mg once daily for 3 to 5 days between treatments. It is better if the above treatment is added with immunotherapy such as interferon, shiitake mushroom polysaccharide, interleukin-2, etc.
(iv) Hepatic artery embolization chemotherapy (TAE)
This is a non-surgical tumor treatment method developed in the 1980s, which has good efficacy in liver cancer and is even recommended as the first choice of non-surgical treatment. Most of the chemotherapeutic agents are mixed with iodinated oil (lipiodol) or 131I or 125I-lipiodol, or 90 yttrium microspheres to embolize the distal blood supply of the tumor, and then gelatin sponge to embolize the proximal hepatic artery of the tumor to make it difficult to establish collateral circulation, resulting in ischemic necrosis of the tumor lesion. Chemotherapeutic agents commonly used are CDDP80~, plus 100mg5Fu 1000mg mitomycin 10mg [or Adriamycin (ADM) 40-60mg], first intra-arterial perfusion, then mixed with mitomycin (MMC) 10mg in ultrasound emulsified Lipiodol for distal hepatic artery embolization. Hepatic artery embolization chemotherapy should be repeated several times for better results. According to the data of our radiology department, the one-year survival rate of 345 cases of large hepatocellular carcinoma that could not be resected surgically was only 11.1% with hepatic artery infusion chemotherapy alone, but the one-year survival rate increased to 65.2% with combined hepatic artery embolization therapy, and the longest survival was 52 months with follow-up. This method is contraindicated for those with severe liver function loss, and it is also inappropriate for those with portal artery trunk obstruction.
(V) Intratumoral injection of anhydrous alcohol
Ultrasound-guided percutaneous hepatic penetration is used to inject anhydrous alcohol into the tumor to treat hepatocellular carcinoma. It is preferred for hepatocellular carcinoma with tumor diameter ≤ 3 cm and the number of nodules less than 3, which is inoperable due to liver cirrhosis. It is possible to cure small hepatocellular carcinoma. The effect of ≥5cm is poor.
(VI) Radiotherapy
Due to the progress of radiation source, radiation equipment and technology, and the accurate positioning of various imaging examinations, the status of radiation therapy in the treatment of liver cancer has been improved, and the efficacy has also been improved. Radiation therapy is suitable for unresectable hepatocellular carcinoma with limited tumor, and its efficacy is usually better if a larger dose is tolerated. External radiation therapy includes whole liver radiation, local radiation, whole liver mobile strip radiation, local super-segmented radiation, and stereoscopic radiation with total amount exceeding nearly useful protons for liver cancer radiation therapy. It has been reported that the total amount of radiation exceeds 40Gy (4000 rads capacity) combined with Chinese herbal medicine for Qi and spleen can make the one-year survival rate reach 72.7% and five-year survival rate reach 10%, and the integrated treatment with surgery and chemotherapy can play the role of killing residual cancer, and chemotherapy can also assist radiotherapy to play the role of sensitization. Intrahepatic arterial injection of Y-90 microspheres, 131I-iodinated oil, or isotope-labeled monoclonal antibodies can play a role in internal radiation therapy.
(vii) Guided therapy
The application of specific antibodies and monoclonal antibodies or pro-tumor chemicals as carriers, labeled with nucleophiles or cross-linked with chemotherapeutic drugs or immunotoxins for specific guidance therapy is one of the promising therapies. Antibodies that have been used clinically include anti-human hepatocellular carcinoma protein antibody, anti-human hepatocellular carcinoma monoclonal antibody, anti-fetoprotein monoclonal antibody, etc. In addition to 131I125I, “warhead” has been tried for 90Y. In addition, cross-linking human monoclonal antibodies or genetically engineered antibodies to toxic proteins and chemotherapeutic drugs and antibodies are under study.
(H) Chemotherapy
CDD[P is the drug of choice for hepatocellular carcinoma, and 5Fu, adriamycin (ADM) and its derivatives, mitomycin, VP16 and methotrexate are also commonly used. Individual drugs are generally considered to be less effective when administered intravenously. The use of hepatic artery administration and/or embolization, as well as the combination of internal and external radiation therapy are more commonly used and have more obvious effects. For some patients with intermediate to advanced hepatocellular carcinoma without surgical indications, and those who are not suitable for hepatic artery intervention due to portal vein trunk obstruction and some patients after palliative surgery, combined or sequential chemotherapy can be used. Adriamycin 40-60mg on the first day, followed by 5Fu500mg-750mg intravenous infusion for 5 days, once a month for 3-4 times for a course of treatment, the effect of the above program evaluation is not consistent.
(ix) Biological therapy
Biological therapy not only plays a role in reducing the suppression of immunity and eliminating residual tumor cells by cooperating with surgery, chemotherapy and radiotherapy. In recent years, the development of recombinant gene technology has made it possible to obtain a large number of immunologically active factors or cytokines. The application of biological response modifiers (BRM) such as recombinant lymphokines and cytokines for tumor biotherapy has attracted widespread attention in the medical field and has been considered as the fourth anti-tumor therapy, and α and γ interferons (IFN) have been commonly used in clinical treatment, natural and recombinant IL-2 and TNF have been introduced. (TIL), etc., have been tested. The efficacy of the various biologic therapeutic agents used remains to be further investigated and evaluated. Gene therapy offers a new prospect for the biological treatment of liver cancer.
VII. Examination
1.Enzymatic examination r-glutamyl transpeptidase and isoenzyme (GGT-II) are significantly elevated in hepatocellular carcinoma, and the positive rate of GGT-II can reach 90%.
2.AFP test is one of the important methods for early diagnosis of hepatocellular carcinoma, with high specificity.
3.Ultrasound imaging B-type ultrasound imaging can show tumor with diameter of 2cm or more, which is of great value for early localization.
4.Electronic computerized X-ray tomography (CT) can show tumor with diameter of 1.0cm or more.
5.Radionuclide scan can show tumors of 3-5cm or more in diameter.
6.Other X-ray hepatic angiography and MRI have certain value in the diagnosis of liver cancer.
VIII. Diet
1.Balanced diet: patients with liver cancer consume a lot and must ensure sufficient nutrition. The simplest way to measure the nutritional status of patients is whether they can maintain their body weight. To maintain normal weight, the best way is to maintain a balanced diet, which requires patients to eat more fresh vegetables, and half of them should be green leafy vegetables.
2.Fat and protein: High-fat diet can affect and aggravate the disease, while low-fat diet can reduce nausea, vomiting, abdominal distension and other symptoms of liver cancer patients. As liver cancer patients have poor appetite and low food intake, if they do not have sufficient amount of balanced diet, they must increase the calorie of the diet and eat crude fat that can be easily digested and absorbed. Liver cancer patients should eat more food rich in plant protein, especially high-quality plant protein.
3.Vitamins: Vitamin A, C, E and K have certain auxiliary anti-tumor effects. Vitamin C is mainly found in fresh vegetables and fruits. Carotene can be converted into vitamin A after entering the body, so liver cancer patients should have more vegetables and fruits with more vc.
4.Inorganic salt: i.e. minerals. Nutritionists divide inorganic salts into two categories: macronutrients, such as calcium, sodium, potassium, etc.; trace elements, such as selenium, zinc, iodine, etc.. Scientists found that selenium, iron and other minerals have anti-cancer effects.
5.Patients with liver cancer mostly have symptoms of indigestion such as loss of appetite, nausea and abdominal distension, so they should eat easily digestible food.
6.Patients with advanced hepatocellular carcinoma are mostly in a state of systemic failure and have difficulties in eating, so they should mainly support themselves and eat easily digestible food.
IX. Prevention
According to a large number of epidemiological surveys in China, the seven-word policy of “change water, prevent mold, prevent hepatitis” or “control water, control food, prevent hepatitis” proposed in the 1970s has not only been effective, but also become the characteristic of primary prevention of liver cancer in China. In the past one or two decades, the incidence rate and mortality rate of liver cancer have been significantly reduced in some areas with high incidence of liver cancer by taking primary prevention measures. Secondary prevention can be summarized as “early detection, early diagnosis and early treatment”. Tertiary prevention means active clinical treatment.
They believe that the prevention of liver cancer should start from the following points.
First, hepatitis should be prevented. The use of hepatitis vaccine to prevent hepatitis and thus liver cancer has become one of the most promising ways to prevent liver cancer. However, it is estimated that it will take decades to see results. In addition to the hepatitis B vaccine, attention should be paid to the control of other transmission routes, such as diet, surgery, blood transfusion, injection, acupuncture and haircut.
One of the causes of hepatocellular carcinoma is caused by virus. To prevent hepatitis B virus also needs to start from dietary hygiene and living habits. It is important to wash hands frequently and share meals. It is worth noting that people with hepatitis should not work as cooks.
Reduce the intake of nitrosamines as well as quit smoking and alcohol. Smoking and drinking are also bad for fatty liver. Drinking wine, beer and a small amount of wine can invigorate the blood, but in fact, it is not so, alcohol is harmful to the human body. The gastric mucosa in the stomach has a protective effect on the body, alcohol can digest the gastric mucosa away, the cells of the stomach are injured, and the toxic substances in food are easily absorbed by the stomach. This can easily cause alcoholic hepatitis, reduce the immune function of the liver and the immune function of the whole body, and damage the detoxification function of the liver. This is why people who drink alcohol have poor detoxification function and are prone to alcoholic cirrhosis, and part of the cirrhosis will turn into liver cancer.
X. Family care for liver cancer patients.
The treatment of liver cancer patients is complicated, and they need to rest for a period of time during treatment without hospitalization. Patients go home to recuperate, which can reduce economic expenses and improve the turnover rate of hospital beds. Home nursing is an integral part of nursing care and is a method to implement ambulatory care for patients. Home care differs from clinical care in form and quality of care. From the patient’s point of view, the patient develops a sense of affection and trust, generates feelings of mutual support and interdependence, and improves the quality of the patient’s survival.
(i) Content of home care
1.Psychologically, patients with liver cancer are impatient and irritable, so family members should understand and tolerate them.
2.Living environment should be kept clean and comfortable, and the room should be ventilated.
3.Basic care should be “six clean” (clean mouth, face, hair, skin of hands and feet, perineum and bed unit), “five preventions” (prevention of bedsores, upright hypotension, respiratory infection, cross*infection and urinary tract infection) and “three no’s” (no feces, no blood pressure, no urinary tract infection). “Three free” (no feces, no bed fall, no burns), “a management” (meal management).
4.Medication safety. Follow the doctor’s orders to use medication on time and in the right amount, and keep the medication well.
5.Health education, guide patients to self-care, correct bad habits, do not smoke, do not drink, improve self-care ability, avoid the adverse effects of harmful stressors, and assist them to maintain mental and physical balance.
6. Encourage patients to participate in normal human life, take part in easy work and appropriate amount of study, and re-establish their survival value in work and study.
(II) Decubitus ulcer care of liver cancer
Patients with hepatocellular carcinoma are bedridden for a long time, and their emaciation and general weakness may lead to the occurrence of bedsores.
The causes of decubitus ulcers are.
① local pressure friction and measurement of displacement.
② local tissue ischemia and necrosis.
③ local moisture and stimulation by excrement.
④Insufficient intake of nutrients. The appearance of decubitus ulcers in chronological order is mainly manifested by bruising and redness, rash, blistering, rupture, local tissue necrosis, and even ulceration, and finally invasion of muscle membranes. Muscle. Bone and other deep tissues. Once decubitus ulcers occur, they not only add to the patient’s pain, aggravate the condition, prolong the course of the disease, but in serious cases can cause sepsis due to secondary infection and endanger life. Therefore, it is important to strengthen basic care to prevent the occurrence of bedsores. The presence or absence of decubitus ulcers is one of the important criteria for judging the quality of care.
(1) Nursing goals
1.Prevent the occurrence or deterioration of decubitus ulcers.
2.Promote the healing of decubitus ulcer wounds.
(2) Nursing measures
Prevention of decubitus ulcers
(1) Promote movement or mobility of the patient. For patients who cannot move, assist them to turn over once every 2 hours; for patients who can move a little, encourage them to move in bed or perform physical exercises with the help of family members.
(2) Instruct the patient the correct method of turning, do not drag, so as not to rub to break the skin.
(3) When lying or sitting for a long time, small pads should be disposed of at the bony prominence to prevent local pressure, and gauze pads can be used to overhead the heel.
(4) Massage the bony prominence with safflower ethanol every day to prevent the occurrence of decubitus ulcers.
(5) Protect the skin cleanliness and swab the skin with warm water every day.