Đang chuẩn bị liên kết để tải về tài liệu:
Hepatobiliary Surgery - part 9

Hiện nay, trị liệu Haipai IS giới hạn trong các thử nghiệm lâm sàng. Kết hợp thuốc khác nhau và có phác đồ Theo điều tra, với mục đích của các cuộc thảo luận hiện nay, chỉ từ Liên quan trực tiếp đến vị trí động mạch gan bơm được duyệt. Kịch bản trong lâm sàng nào IS coi Haipai năm bao gồm: | 228 Heptobiliary Surgery When Should HAIP Therapy Be Considered At present HAIP therapy is limited to clinical trials. Various drug regimens and combinations are under investigation for the purpose of the present discussion only issues pertaining directly to hepatic artery pump placement are reviewed. Clinical scenarios in which an HAIP is considered include 1. Liver resection and colectomy in combination with HAIP placement. 2. Liver resection in combination with HAIP placement. 3. HAIP placement alone without liver resection or colectomy. 4. Nonsurgical ablative therapy in combination with HAIP placement. The rationale for the use of HAIP chemotherapy is to provide regional treatment for patients considered to be at high-risk for the local recurrence progression or persistence of disease. Patients at high-risk may include those presenting with synchronous colon and hepatic disease hepatic metastases within 24 months of the primary tumor or patients undergoing hepatic resection with minimal free margins or demonstrated persistent disease. Nonresectional hepatic ablative therapies e.g. radiofrequency ablation cryoablation for patients not otherwise candidates for surgical resection have been popularized by the early promising results demonstrated in small series. In these patients HAIP therapy may be used as a component of their treatment. However the long-term outcome for this approach remains to be established. Preoperative Patient Evaluation This section will be necessarily brief as the topic of metastatic work-up for patients with colorectal cancer is covered elsewhere. Patient eligibility for enrollment into clinical trial is specifically defined by the study protocol. In general the following criteria are common to most HAIP clinical trials History of histologically confirmed colorectal adenocarcinoma metastatic to the liver with no clinical or radiographic evidence of extrahepatic disease. Liver metastases must comprise 70 of the liver parenchyma. WBC 3 500