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Abstract: A 46-year-old patient had pain in the right upper abdomen 2 months ago and did not care about it. 1 week ago, he developed severe pain and came to the county hospital for examination and found a liver mass. An abdominal ultrasound was done to suggest an occupying lesion in the liver, and hepatocellular carcinoma was considered. After discussion with the patient, laparoscopic hepatic left outer lobe resection was performed, and the operation went very well. The patient’s condition was controlled and the postoperative pathology was clearly diagnosed.
Basic information】Male, 46 years old
Disease Type】Hepatocellular carcinoma
Hospital】The First Hospital of Jilin University
Date of consultation】December 2021
Treatment plan】Surgical treatment (laparoscopic hepatic left outer lobe resection)
Treatment period】7 days of inpatient treatment, 1, 3, 6 months of outpatient follow up
Effectiveness of treatment] The disease is under control, anti-tumor treatment is in progress
I. Initial interview
The patient had a typical chronic liver disease face, with a dark, slightly yellowish complexion at the time of consultation. After asking about his condition, the patient developed pain in the right upper abdomen 2 months ago and did not pay attention to it. 1 week ago, he developed severe pain at night that lasted 3-5 minutes, and on the second day, he went to the county hospital for an abdominal ultrasound examination, which suggested a liver mass. The patient indicated that he had jaundiced hepatitis as a child, had a family history of hepatitis B, but had no regular and standardized treatment, usually loved to drink alcohol, 3-4 taels per day, had not had surgery, and had no other special conditions. The abdominal ultrasound indicated an occupying liver lesion, not excluding malignant, with hepatic density inhomogeneity, considering the possibility of cirrhosis. At present, combined with the patient’s medical history, the reason for the appearance of chronic liver disease face is due to long-term uncontrolled hepatitis, which may cause cirrhotic nodules due to hepatitis, while liver occupancy needs to be alert to the possibility of liver cancer. The current preliminary diagnosis is liver tumor, but whether it is a malignant tumor requires further examination, and there are laboratory tests to be perfected.
II. Treatment history
The patient underwent hepatobiliary-pancreatic enhanced CT, tumor markers and liver function examinations. The examination results showed that the tumor in the liver was located in the left outer lobe with a diameter of about 4 cm, which was considered to be hepatocellular carcinoma. The patient agreed to further surgical treatment. After the preoperative preparation, laparoscopic resection of the left outer lobe of the liver was performed, which was a minimally invasive surgery. The bleeding during the operation was very low and smooth.
III. Treatment results
The patient’s postoperative recovery was smooth, and there were no serious postoperative complications, no bleeding, no bile leakage, and no serious liver function impairment, and he was discharged on the third postoperative day after the drainage tube was removed and he started to eat, and after exhaustion, he started to get out of bed. At the time of discharge, the patient’s general condition was significantly better than before, abdominal pain disappeared, diet recovered well, no obvious accumulation of fluid and blood in the abdominal ultrasound, liver function transaminases and other indicators improved significantly. The specific anti-tumor treatment can be chosen from interventional chemoembolization, immunotherapy or targeted therapy, to which the patient agreed. The patient was instructed to have regular postoperative reviews at 1 month, 3 months and 6 months, including liver function, tumor markers and enhanced CT of the liver, bile and pancreas.
IV. Precautions
We are glad that after the treatment, the patient’s condition has been significantly controlled. The treatment of hepatocellular carcinoma is a long-term process. On the one hand, we feel sorry for the patient for not treating hepatitis B for a long time in the past, and on the other hand, we are glad that the patient has the opportunity to be treated surgically.
1, must do a good job of postoperative symptom monitoring, if the discharge abdominal pain, fever and other conditions at any time to consult, need to intermittently recheck liver function, tumor markers and hepatobiliary and pancreatic enhancement CT to clarify whether the tumor has recurrence, metastasis.
2. After the conventional surgical treatment, anti-tumor therapy should be taken regularly and reasonably, which includes interventional embolization therapy, immunotherapy and targeted therapy, etc.
3. patients should take anti-hepatitis B virus treatment from the drug level, only by inhibiting the proliferation of virus can liver function be protected.
4. In terms of life, patients should resume their diet after discharge, make reasonable dietary and postoperative adjustments, carry out a high-protein, high-nutrient diet, and can appropriately carry out activities such as jogging.
V. Personal insight
1.Hepatocellular carcinoma is a common type of malignant tumor with insidious and long development. The most common pathogenic factor is cirrhosis due to further hepatitis B or C. Long-term carcinoma of cirrhotic nodules leads to hepatocellular carcinoma.
2. For the diagnosis of hepatocellular carcinoma, the commonly used methods include abdominal ultrasound, enhanced CT, tumor markers, etc. However, sometimes these methods are limited and ineffective, and we also need to observe clinical symptoms in clinical practice, including the prevention and treatment of hepatitis is very important.
3. For the treatment of hepatocellular carcinoma, surgery is the conventional method, and after the treatment of surgical method, anti-tumor comprehensive treatment should be carried out according to the pathological results, which includes interventional embolization therapy, immunotherapy and targeted therapy, etc.
Although the patient in this case was not treated in time, it is good that her condition improved after subsequent treatment and she obtained a more satisfactory treatment effect.