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Abstract: The patient, Uncle Wang, 71 years old, presented to our hospital with complaints of uncomfortable symptoms in the right upper abdomen for more than half a year, and in the last half month, severe distension in the right upper abdomen, poor appetite and weight loss of 5 kg. Ultrasound and CT examination indicated liver occupancy, the nature of which was uncertain, and tumor markers were within the normal range. After the surgery, uncle Wang’s upper abdominal discomfort was significantly relieved and his condition was controlled and stabilized.
Basic information】Male, 71 years old
Disease Type】Hepatic hemangiosarcoma
Hospital】Liaocheng People’s Hospital
Date of Consultation】November 2021
Treatment plan】Surgical treatment (hepatic hemangiosarcoma resection) + intravenous infusion (piperacillin sodium tazobactam sodium for injection, fatty milk amino acid (17) glucose (19%) injection) + oral medication (diammonium glycyrrhizate enteric capsule, omeprazole enteric capsule)
[Treatment cycle] Hospitalization for 10 days, regular review
【Treatment effect】The discomfort symptoms were relieved, and the condition was basically controlled and stable
I. Initial consultation
When we first saw the patient, he was relatively thin, and he reported that he had been experiencing continuous discomfort in the right upper abdomen for about six months, and recently his right upper abdominal distension and pain had gradually increased, accompanied by poor appetite and weight loss of 5 kg in the past two months. Malignant tumor was not excluded. The patient was advised to further clarify the diagnosis and hospitalization, to which the patient agreed.
After admission, the patient underwent routine blood and liver function tests, the results of which showed that they were within the normal range, and the tumor markers CEA, C199 and AFP were not significantly elevated.
II. Treatment process
After discussing with the patient and his family, we decided to give surgical treatment to remove the tumor radically and decide the next treatment according to the tumor pathology. Firstly, the patient was given routine blood tests and drug sensitivity tests, which met the preoperative preparation criteria. The patient was prepared for surgical treatment. Under general anesthesia, the patient underwent hepatic tumor resection, and some tissues were taken for pathological examination.
After surgery, the patient was given piperacillin sodium tazobactam sodium by injection for anti-infection treatment, oral diammonium glycyrrhizate enteric capsules for liver protection, omeprazole enteric capsules to inhibit gastric acid secretion, and intravenous fatty lactic amino acid (17) glucose (19%) injection for parenteral nutrition treatment.
III. Treatment results
The patient had good intraoperative anesthesia and returned to the ward safely after surgery. After postoperative treatment with anti-infection, hepatoprotection, acid suppression and nutrition, the patient’s wound did not show redness, swelling and exudate on the first day of hospitalization, and only slight pain was observed, which was normal. On the second day, the patient’s liver function gradually returned to normal, parenteral nutrition was stopped, and a small amount of light, liquid food was given, and the patient indicated that the right upper abdominal distension and discomfort gradually decreased. On the third day of hospitalization, the patient was given semi-liquid food, and the wound was observed to be drier and no infection or bleeding occurred. On the 10th day of hospitalization, the symptoms of right upper abdominal distension and pain disappeared, the condition was basically stable, the treatment effect was good, and the patient was more satisfied, so he was discharged from hospital.
IV. Precautions
I am very happy that the patient’s condition is basically stable after surgery and regular drug treatment, but I still need to advise the patient the following precautions.
1.After discharge, the patient should pay more attention to rest and avoid strenuous activities so as to avoid incisional dehiscence.
2, gradually increase the amount of food after discharge, and try to eat light, nutritious food, such as eggs, spinach, lean meat, etc..
3.Patients need to return to the hospital for review when they have recovered well in mental, physical and feeding after discharge. Because the patient’s pathology is confirmed to be hepatic hemangiosarcoma, this kind of malignant tumor has a high degree of malignancy and is prone to recurrence or distant metastasis in the early stage.
V. Personal insight
Hepatic hemangiosarcoma is a rare type of hepatic malignant tumor, which has a high degree of malignancy and is prone to distant metastasis in early stage. If there is a chance of radical resection like the patient in this case, surgical resection of hepatic hemangiosarcoma is preferred, followed by chemotherapy, interventional therapy, immunotherapy, targeted therapy and other treatments. If the patient has distant metastasis or local invasion at the time of discovery and cannot be surgically removed, comprehensive treatment such as chemotherapy can be chosen. Meanwhile, although hepatic hemangiosarcoma is a malignant tumor, patients still need to be treated actively and to keep their mood relaxed and avoid excessive tension and anxiety during the treatment process.