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Abstract: A patient reported pain in the right upper abdomen for half a month during an outpatient visit. The patient underwent laparoscopic hepatectomy under general anesthesia, and the postoperative pathology confirmed the diagnosis of hepatocellular carcinoma. After the operation, the patient was given antiviral, hepatoprotective and anti-infective treatment. The patient’s symptoms of right upper abdominal distension and pain gradually disappeared, and his condition was stabilized and liver function gradually returned to normal.
Basic information】Male, 56 years old
Disease Type】Hepatocellular carcinoma
Hospital】Liaocheng People’s Hospital
Date of Consultation】November 2021
Treatment plan] Hepatocellular carcinoma resection + drug treatment (injectable penicillin sodium, entecavir tablets, diammonium glycyrrhizate capsules)
Treatment period】Inpatient treatment for 10 days, returned to hospital for interventional treatment 1 month after surgery
Treatment effect】The patient’s symptoms of right upper abdominal distension and pain gradually disappeared, the condition was stable, and liver function gradually returned to normal.
I. Initial consultation
At the time of consultation, the patient reported right upper abdominal pain for half a month, and the nature of the pain was mainly distension. After examination at a local clinic, it was judged to be a liver problem, so he came to the clinic for liver examination. The patient was routinely given an abdominal ultrasound examination, which suggested that the patient’s liver was a manifestation of chronic liver disease, and there was also an occupancy of about 4 cm in diameter in the right liver, which was considered to be hepatocellular carcinoma. When asked about the patient’s medical history, the patient denied having a history of viral hepatitis, but the patient’s mother had hepatitis B, and the patient had never checked whether she had hepatitis B. Therefore, the patient was initially considered to have hepatocellular carcinoma and was admitted to the hospital for further treatment.
II. Treatment history
After admission, the patient was routinely screened for viruses, which indicated the presence of chronic viral hepatitis B. The AFP index was significantly elevated, but the patient’s liver function was basically within the normal range. The repeat abdominal intensive CT indicated that there was an occupancy of about 4 cm in diameter in the right anterior lobe of the liver, with enhancement at the edge, and the possibility of hepatocellular carcinoma was considered. Since the patient’s tumor was small and no metastasis was found in other parts, the treatment plan was surgical resection of the tumor. After explaining the patient’s condition to his family, they agreed to the surgical treatment plan. The patient then underwent laparoscopic resection of hepatocellular carcinoma under general anesthesia. The operation was relatively smooth and the postoperative pathology confirmed that it was hepatocellular carcinoma. The patient was routinely treated with injectable penicillin sodium to fight infection, entecavir tablets to fight hepatitis B virus, and diammonium glycyrrhizate capsules to protect the liver after surgery. The patient recovered well after surgery and was discharged from the hospital in 10 days.
III. Treatment effect
Since the patient underwent minimally invasive laparoscopic surgery, the operation was less invasive and he could get out of bed on the first postoperative day, and he could start eating when he had gas and bowel movement on the second postoperative day. As the treatment progressed, the patient’s symptoms of right upper abdominal distention and pain gradually disappeared, his condition stabilized, his liver function gradually returned to normal, his food intake gradually increased, and his strength returned to normal, and he was discharged after 10 days of hospitalization. Because the patient currently has chronic viral hepatitis B, and the occurrence of hepatocellular carcinoma is associated with viral hepatitis, the patient was given antiviral treatment, and the patient’s hepatitis B virus quantification is now continuing to decrease.
IV. Notes
We are glad that the patient’s condition is stable and his discomfort disappears after treatment. However, the patient should also pay more attention to rest and increase nutrition after discharge, and gradually adjust his body to a better state. The patient has chronic viral hepatitis B with relatively high viral quantification, so anti-hepatitis B virus drugs, such as entecavir tablets, should be taken for life. Patients should also have regular review. They should be admitted to hospital for one interventional treatment one month after surgery to consolidate the treatment effect, and have a routine physical examination every six months after surgery to review liver function, abdominal ultrasound, liver cancer tumor markers, and hepatitis B virus quantification to actively control hepatitis B and prevent tumor recurrence.
V. Personal insight
Most of the liver cancers in our country are related to chronic hepatitis B. Many patients, like the patient in this case, do not have a high awareness of preventive health care and do not routinely undergo medical checkups, thus not discovering that they are hepatitis B patients and thus delaying treatment. Chronic hepatitis B can lead to the gradual development of liver cirrhosis and thus liver cancer. Therefore, patients with hepatitis B must pay attention to regular medical checkups and actively treat hepatitis B to achieve early detection and early treatment.