{"id":168,"date":"2017-07-13T16:19:52","date_gmt":"2017-07-13T08:19:52","guid":{"rendered":"http:\/\/web.csh.org.tw\/web\/224020\/?page_id=168"},"modified":"2017-07-13T16:20:47","modified_gmt":"2017-07-13T08:20:47","slug":"t","status":"publish","type":"page","link":"https:\/\/web.csh.org.tw\/web\/224020\/?page_id=168","title":{"rendered":"\u809d\u764c\u5728\u53f0\u7063"},"content":{"rendered":"

\u809d\u764c\u5728\u53f0\u7063 – \u6797\u656c\u658c\u91ab\u5e2b<\/strong><\/p>\n

\u6d41\u884c\u75c5\u5b78
\n\u4e00\u3001\u767c\u751f\u7387\u53ca\u76db\u884c\u7387
\n\u809d\u7d30\u80de\u764c (Hepatocellular carcinoma\uff0c\u4ee5\u4e0b\u7c21\u7a31\u809d\u764c) \u7684\u767c\u751f\u7387\u5728\u7537\u6027\u662f\u6bcf\u5341\u842c\u4eba\u6709\u4e8c\u5341\u4e94\u4eba\uff0c\u5728\u5973\u6027\u662f\u6bcf\u5341\u842c\u4eba\u6709\u5341\u4eba\u3002\u5e74\u767c\u751f\u7387\u5728\u6162\u6027 B\u578b\u809d\u708e\u7684\u4eba\u662f0.826 \uff05\uff0c\u5728\u5927\u65bc35\u6b72\u7684\u6162\u6027 B\u578b\u809d\u708e\u75c5\u4eba\u662f2.77\uff05\uff0c\u5728\u809d\u786c\u5316\u7684\u4eba\u662f5.6 \uff05\uff0c\u5728B \u578b\u809d\u708e\u75c5\u6bd2\u8868\u9762\u6297\u539f(HBsAg) \u9670\u6027\u7684\u809d\u786c\u5316\u75c5\u4eba\u662f4.5-6.2 \uff05\uff0c\u5728HBsAg \u967d\u6027\u7684\u809d\u786c\u5316\u75c5\u4eba\u662f5.7-7.7 \uff05\u3002\u809d\u764c\u7684\u76db\u884c\u7387\u5728\u9e7f\u8c37\u910940\u6b72\u81f369\u6b72\u7684\u7537\u6027\u662f0.32\uff05\uff0c\u5728\u6f8e\u6e56\u7fa4\u5cf6\u662f0.16\uff05\u3002 \u809d\u764c\u662f\u53f0\u7063\u6700\u5e38\u898b\u7684\u60e1\u6027\u816b\u7624\uff0c\u5728\u6c11\u570b69\u5e74\u7684\u7d71\u8a08\u4e2d\uff0c\u7537\u6027\u8207\u5973\u6027\u7684\u6bcf\u5341\u842c\u4eba\u6b7b\u4ea1\u7387\u5206\u5225\u662f26.10 \u53ca8.14\uff0c\u53f0\u7063\u7684\u809d\u764c\u5e74\u9f61\u6a19\u6e96\u5316\u6b7b\u4ea1\u7387\u9ad8\u65bc\u65e5\u672c\u53ca\u65b0\u52a0\u5761\u3002<\/p>\n

\u4e8c\u3001\u5730\u7de3\u5206\u5e03
\n\u53f0\u7063\u7684\u809d\u764c\u6b7b\u4ea1\u7387\u5728\u6771\u90e8\u5c71\u5340\u6709\u986f\u8457\u7684\u8f03\u9ad8\uff0c\u800c\u5728\u897f\u90e8\u5c71\u5340\u5247\u8f03\u4f4e\u3002\u6700\u9ad8\u7684\u6b7b\u4ea1\u7387\u898b\u65bc\u6f8e\u6e56\u7fa4\u5cf6\uff0c\u70cf\u8173\u75c5\u5206\u5e03\u5340\u53ca\u6771\u90e8\u5c71\u5340\u539f\u4f4f\u6c11\u5c45\u4f4f\u5e02\u93ae\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\u90e8\u5206\u9ad8\u6b7b\u4ea1\u7387\u5340\u6070\u597d\u4e5f\u662f\u70cf\u8173\u75c5\u76db\u884c\u5340\u3002\u6b64\u9ede\u986f\u793a\u74b0\u5883\u56e0\u7d20\u5c0d\u809d\u764c\u7684\u767c\u751f\u4e5f\u4f54\u4e00\u91cd\u8981\u5730\u4f4d\u3002<\/p>\n

\u4e09\u3001\u5e74\u9f61
\n\u809d\u764c\u6700\u76db\u884c\u7684\u5e74\u9f61\u898b\u65bc31\u81f360\u6b72\u4e4b\u9593\uff0c\u5728\u6c11\u570b50\u5e74\u4ee3\uff0c\u6700\u9ad8\u7684\u767c\u751f\u7387\u662f\u572841 \u81f350\u6b72\u4e4b\u9593\uff0c\u4f46\u5728\u723e\u5f8c\u7684\u7814\u7a76\u5247\u70ba50\u81f360\u6b72\u3002\u809d\u786c\u5316\u4f75\u767c\u809d\u764c\u7684\u5e73\u5747\u5e74\u9f61\u662f56.7\u6b72\uff0c\u5728\u975e\u809d\u786c\u5316\u8005\u5247\u70ba52\u6b72\u3002HBsAg \u967d\u6027\u7684\u809d\u764c\u75c5\u4eba\uff0c\u5176\u5e73\u5747\u5e74\u9f61\u662f55\u6b72\uff0c\u800c\u5728HBsAg \u9670\u6027\u4e14C \u578b\u809d\u708e\u75c5\u6bd2\u6297\u9ad4\u967d\u6027\u7684\u809d\u764c\u75c5\u4eba,\u5176\u5e73\u5747\u5e74\u9f61\u662f65.7 \u6b72\u3002<\/p>\n

\u5f9e\u5c0f\u5152\u79d1\u809d\u764c\u75c5\u4eba\u7684\u7814\u7a76\u4e2d\uff0c\u53ef\u767c\u73fe\u6709HBsAg \u53ca\u809d\u764c\u5bb6\u65cf\u805a\u96c6\u7684\u73fe\u8c61\uff0c\u4e14\u809d\u764c\u5152\u7ae5\u7684\u6bcd\u89aa\u4e2d\uff0c\u670993.3\uff05\u662fHBsAg \u967d\u6027\u3002\u5728\u5c0f\u5152\u539f\u767c\u6027\u60e1\u6027\u809d\u816b\u7624\u4e2d\uff0c\u809d\u764c\u7684\u767c\u751f\u7387\u9060\u5927\u65bc\u809d\u82bd\u7d30\u80de\u764c(hepatoblastoma) \uff0c\u6b64\u9ede\u8207\u65e5\u672c\u53ca\u7f8e\u570b\u5927\u4e0d\u76f8\u540c\u3002<\/p>\n

\u56db\u3001\u6027\u5225
\n\u7537\u6027\u6bd4\u5973\u6027\u7684\u6bd4\u4f8b\u662f3-8 \uff1a1 \uff0c\u5728\u5c0f\u5152\u79d1\u75c5\u4eba\u70ba4\uff1a1\u3002\u5f9e\u809d\u764c\u6b7b\u4ea1\u7387\u7684\u9577\u671f\u8da8\u52e2\u770b\u4f86\uff0c\u7537\u6027\u7684\u6b7b\u4ea1\u7387\u589e\u52a0\uff0c\u800c\u5973\u6027\u5247\u7121\u591a\u5927\u6539\u8b8a\uff1b\u6b64\u7a2e\u7537\u5973\u6709\u5225\u7684\u7d50\u679c\u6697\u793a\u8457\u9664\u4e86B \u578b\u809d\u708e\u75c5\u6bd2\u4e4b\u5916\uff0c\u5176\u4ed6\u7684\u56e0\u7d20\uff08\u5982\u6027\u8377\u723e\u8499\uff09\u5728\u809d\u764c\u7684\u75c5\u56e0\u5b78\u4e0a\u4f54\u6709\u91cd\u8981\u7684\u89d2\u8272\u3002<\/p>\n

\u4e94\u3001\u6c11\u65cf\u5718\u9ad4
\n\u539f\u4f4f\u6c11\u6709\u8f03\u9ad8\u7684\u809d\u764c\u6b7b\u4ea1\u7387\uff0c\u800c\u5ba2\u5bb6\u4eba\u5247\u6709\u8f03\u4f4e\u7684\u6b7b\u4ea1\u7387\u3002<\/p>\n

\u516d\u3001\u5371\u96aa\u56e0\u5b50
\n\u53ef\u80fd\u7684\u5371\u96aa\u56e0\u5b50\u5305\u62ecHBsAg \u967d\u6027\u6162\u6027\u809d\u708e\u3001\u809d\u786c\u5316\u3001\u5bb6\u65cf\u6709\u809d\u764c\u75c5\u4eba\uff0c\u6709\u809d\u75c5\u7684\u65e2\u5f80\u53f2\uff0c\u7d05\u8840\u7403Rh\u7cfb\u7d71c \u6297\u539f\u967d\u6027,C \u578b\u809d\u708e\u7684\u611f\u67d3\u4e5f\u88ab\u8a8d\u70ba\u662f\u809d\u764c\u7684\u5371\u96aa\u56e0\u5b50\u3002<\/p>\n

\u7537\u6027\u516c\u52d9\u4eba\u54e1\u4e2d40\u6b72\u4ee5\u4e0a\uff0cB \u578b\u809d\u708e\u75c5\u6bd2\u5e36\u539f\u8005\u5c0d\u975e\u5e36\u539f\u8005\u6703\u5f97\u5230\u809d\u764c\u7684\u76f8\u5c0d\u5371\u96aa\u6027\u662f223\uff0c\u4f46\u5728\u723e\u5f8c\u7684\u8ffd\u8e64\u5247\u70ba98.4\u3002HBsAg\u53caHBeAg\uff08B \u578b\u809d\u708e\u75c5\u6bd2e \u6297\u539f\uff09\u7686\u70ba\u9670\u6027\u8005\u5176\u52dd\u7b97\u6bd4\uff08odds ratio\uff09\u70ba1\uff0cHBsAg\u967d\u6027\u800cHBeAg \u9670\u6027\u8005\u5247\u589e\u70ba17.9\uff0c\u5728HBsAg \u53caHBeAg \u7686\u70ba\u967d\u6027\u7684\u75c5\u4eba\uff0c\u5176\u52dd\u7b97\u6bd4\u5247\u9ad8\u905464.7\u3002<\/p>\n

\u62bd\u7159\u3001\u559d\u9152\u3001\u82b1\u751f\u6d88\u8017\u91cf\u3001\u751f\u9b5a\u7247\u651d\u53d6\u7684\u983b\u7387\u3001\u5fc3\u81df\u75be\u75c5\u3001\u6d88\u5316\u6027\u6f70\u760d\u3001\u7627\u75be\u3001\u9ad8\u8840\u58d3\u3001\u7cd6\u5c3f\u75c5\u3001\u8f38\u8840\u3001\u7236\u6bcd\u6216\u5b50\u5973\u662f\u5426\u6709\u809d\u75c5\u7b49\u7b49\uff0c\u7686\u8207\u809d\u764c\u7121\u95dc\u3002<\/p>\n

\u81e8\u5e8a\u8868\u73fe
\n1.\u5c0d\u5df2\u77e5\u6709\u809d\u708e\u3001\u9ec3\u75b8\u3001\u809d\u786c\u5316\u75c5\u53f2\u7684\u75c5\u4eba\u6bcf\u5e74\u5169\u6b21\u7684\u5b9a\u671f\u7be9\u6aa2\u767c\u73fe\u6709\u7570\u5e38\u3002
\n\uff081\uff09\u964d\u4f4e\u816b\u7624\u6b7b\u4ea1\u7387\u7684\u552f\u4e00\u9078\u64c7\u662f\u5b9a\u671f\u76e3\u6e2c\u75c5\u4eba\u4ee5\u4fbf\u63d0\u65e9\u767c\u73fe\u816b\u7624\u800c\u5373\u6642\u7d66\u4e88\u6709\u6548\u7684\u6cbb\u7642\u3002\u56e0\u6b64\u5b9a\u671f\u76e3\u6e2c\u5fc5\u9808\u4fb7\u9650\u5728\u5982\u679c\u8a3a\u65b7\u809d\u764c\u6642\u9084\u80fd\u5920\u6cbb\u7642\u7684\u809d\u786c\u5316\u75c5\u4eba\uff0c\u4e5f\u5c31\u662f\u8aaa\u665a\u671f\u809d\u786c\u5316(Child-Pugh class C)\u548c\u6709\u56b4\u91cd\u5167\u79d1\u75be\u75c5\u7684\u75c5\u4eba\u662f\u4e0d\u5fc5\u76e3\u6e2c\u7684(\u53cd\u6b63\u842c\u4e00\u5f97\u5230\u809d\u764c\u4e5f\u7121\u6cd5\u63a5\u53d7\u6cbb\u7642)\u3002\u6839\u64da\u816b\u7624\u9ad4\u7a4d\u52a0\u500d\u6642\u9593\u662f3~4\u500b\u6708\uff0cBruix(J Hepatol 2001)\u5efa\u8b70\u6bcf\u534a\u5e74\u5b9a\u671f\u6aa2\u67e5\u80ce\u5152\u86cb\u767d\u548c\u809d\u81df\u8d85\u97f3\u6ce2\uff0c\u9075\u5faa\u9019\u500b\u65b9\u5f0f\u627e\u5230\u7684\u816b\u7624\u670950%\u4ee5\u4e0a\u662f\u55ae\u4e00\u7684(solitary)\uff0c\u4f46\u662f\u5176\u4e2d\u53ea\u6709\u4e00\u534a\u53ef\u4ee5\u63a5\u53d7\u6839\u9664\u6027\u6cbb\u7642\u3002<\/p>\n

\uff082\uff09\u80ce\u5152\u86cb\u767d(AFP)\u548c\u809d\u81df\u8d85\u97f3\u6ce2:
\n\u6771\u65b9\u4eba\u7684\u809d\u764c\u670980-90%\u6703\u4e0a\u5347\uff0c\u5728\u7f8e\u570b\u548c\u6b50\u6d32\u53ea\u670960-70%\u7684\u75c5\u4eba\u6703\u4e0a\u5347\uff0c \u809d\u81df\u8d85\u97f3\u6ce2\u662f\u66f4\u70ba\u654f\u611f\u7684\u65b9\u5f0f\u3002\u5728\u9ad8\u5371\u96aa\u7fa4\u8d85\u97f3\u6ce2\u662f\u6bd4\u80ce\u5152\u86cb\u767d\u4e0a\u5347\u66f4\u654f\u611f\u3002<\/p>\n

\uff083\uff09\u9ad8\u5371\u96aa\u7fa4\u7be9\u6aa2\u7684\u81e8\u5e8a\u610f\u7fa9:
\n\u5728\u7fa9\u5927\u5229\u7684\u809d\u786c\u5316\u75c5\u4eba\u6bcf\u5e74\u627e\u52303%\u809d\u764c\u767c\u751f\u7387\uff0c\u4f46\u4e26\u6c92\u6709\u589e\u52a0\u53ef\u80fd\u6cbb\u7652\u816b\u7624(potentially curable tumor)\u7684\u5075\u6e2c\u7387\u3002Sherman(Semin Oncol 2001)\u4e5f\u6307\u51fa\u5c0d\u9ad8\u5371\u96aa\u7fa4\u9032\u884c\u76e3\u6e2c\u4e0d\u80fd\u5ef6\u9577\u5b58\u6d3b\u3002\u7be9\u6aa2\u4e26\u7121\u6cd5\u6539\u8b8a\u58fd\u547d\uff0c \u9810\u9632\u624d\u80fd\u589e\u52a0\u58fd\u547d\u3002\u96d6\u7136\u76ee\u524d\u4ecd\u5efa\u8b70\u5c0d\u9ad8\u5371\u96aa\u65cf\u7fa4\u9032\u884c\u7be9\u6aa2\uff0c\u672a\u4f86\u9019\u4e9b\u75be\u75c5\u58fd\u547d\u7684\u4e3b\u8981\u6539\u8b8a\u4e0d\u662f\u4f86\u81ea\u7be9\u6aa2\uff0c\u800c\u662f\u4f86\u81ea\u5305\u62ecB\u578b\u809d\u708e\u75ab\u82d7\u666e\u904d\u63a5\u7a2e\u7684\u9810\u9632\u6027\u7b56\u7565\u3002<\/p>\n

2.\u75c5\u4eba\u56e0\u70ba\u5176\u4ed6\u7684\u539f\u56e0\u6216\u5e38\u898f\u5167\u79d1\u6aa2\u67e5\u7684\u4e00\u90e8\u5206\u800c\u5f97\u5230\u4e0d\u6b63\u5e38\u7684\u809d\u529f\u80fd\u3002<\/p>\n

3.\u75c5\u4eba\u56e0\u767c\u71d2\u6216\u9ad4\u91cd\u6e1b\u8f15\u800c\u88ab\u6aa2\u67e5\u3002<\/p>\n

4.(\u66f4\u5c11\u898b)\u809d\u764c\u75c7\u72c0\u5305\u62ec\u816b\u7624\u7834\u88c2(\u8840\u6027\u8179\u819c\uff0chemoperitoneum)\u3001\u60e1\u75c5\u8cea(cachexia)\u3001\u8179\u75db\u3001\u6216\u7531\u65bc\u809d\u786c\u5316\u9580\u975c\u8108\u9ad8\u58d3\u7684\u80c3\u8178\u9053\u51fa\u8840\u3002<\/p>\n

\u7406\u5b78\u6aa2\u67e5
\n1.\u75c5\u53f2\uff0d\u78ba\u5b9a\u8a3a\u65b7\uff1a
\n\uff081\uff09\u7d93\u76ae\u7a7f\u523a\u5207\u7247(core biopsy)\u662f\u5fc5\u8981\u7684\uff0c\u56e0\u70ba\u8a3a\u65b7\u809d\u764c\u6240\u5fc5\u9808\u7684\u91cd\u8981\u7d50\u69cb\u6703\u88ab\u7d30\u91dd\u62bd\u5438(FNA)\u932f\u5931\uff0c\u7d30\u91dd\u62bd\u5438(FNA)\u5e38\u4e0d\u8db3\u4ee5\u505a\u8a3a\u65b7\u3002
\n\uff082\uff09\u6709\u809d\u786c\u5316\u7684\u60c5\u6cc1\u800c\u5207\u7247\u6aa2\u9ad4\u6c92\u6709”\u5178\u578b”\u7684\u809d\u764c\u8868\u73fe\u9700\u8981\u7279\u6b8a\u67d3\u8272\uff0c\u5305\u62ec AFP\u3001reticulin\u3001desmin\u3001polyclonal CEA\u3001\u548c mucin\u67d3\u8272(\u7528\u4f86\u6392\u9664)\u3002<\/p>\n

2.\u975e\u4fb5\u72af\u6027\u8a3a\u65b7\u6a19\u6e96(non-invasive criteria):<\/p>\n

\u5207\u7247\u8a3a\u65b7\u4e0d\u662f\u5f37\u5236\u6027\u7684\uff0cBruix(J Hepatol 2001)\u5c0d\u5927\u65bc2\u516c\u5206\u7684\u816b\u7624\u767c\u5c55\u51fa\u975e\u4fb5\u72af\u6027\u8a3a\u65b7\u6a19\u6e96\u3002\u56e0\u6b64\uff0c\u809d\u764c\u53ef\u4ee5\u4e0b\u5169\u7a2e\u65b9\u5f0f\u53ef\u9760\u5730\u8a3a\u65b7:<\/p>\n

\uff081\uff09\u5169\u7a2e\u5f71\u50cf\u5b78\u6aa2\u67e5(\u8d85\u97f3\u6ce2\u3001\u96fb\u8166\u65b7\u5c64\u3001\u6838\u78c1\u5171\u632f)\u4e00\u81f4\u986f\u793a\u5927\u65bc2\u516c\u5206\u800c\u4e14\u52d5\u8108\u591a\u8840\u7ba1(hypervascular)\u7684\u816b\u7624\u3002
\n\uff082\uff09\u4e00\u7a2e\u5f71\u50cf\u5b78\u6aa2\u67e5\u5408\u4f75\u80ce\u5152\u86cb\u767d\u5927\u65bc400ng\/ml\u3002<\/p>\n

TNM\u75be\u75c5\u5206\u671f\u7cfb\u7d71
\n2002\u5e74AJCC\u5206\u671f\u6a19\u6e96:
\nStage I
\nT1
\n\u55ae\u9846\u816b\u7624\u800c\u4e14\u6c92\u6709\u8840\u7ba1\u4fb5\u72af<\/p>\n

Stage II
\nT2
\n\u55ae\u9846\u816b\u7624\u6709\u8840\u7ba1\u4fb5\u72af, \u6216\u591a\u9846\u816b\u7624\u4e14\u6c92\u6709\u4e00\u9846\u8d85\u904e5\u516c\u5206<\/p>\n

IIIa
\nT3
\n\u591a\u9846\u816b\u7624\u4e14\u4efb\u4e00\u9846\u8d85\u904e5\u516c\u5206, \u6216\u816b\u7624\u4fb5\u72af\u9580\u975c\u8108\u6216\u809d\u975c\u8108\u7684\u4e3b\u8981\u5206\u652f<\/p>\n

IIIb
\nT4
\n\u816b\u7624\u76f4\u63a5\u4fb5\u72af\u81bd\u56ca\u4ee5\u5916\u7684\u9130\u8fd1\u5668\u5b98\u6216\u7a7f\u900f\u81df\u58c1\u8179\u819c(visceral peritoneum)<\/p>\n

IIIc
\nN1
\n\u5340\u57df\u6dcb\u5df4\u8f49\u79fb<\/p>\n

Stage IV
\nM1
\n\u9060\u8655\u8f49\u79fb<\/p>\n

F0 \u7b2c0-4\u7d1a\u7e96\u7dad\u5316(\u7121\u5230\u4e2d\u5ea6\u7e96\u7dad\u5316)<\/p>\n

F1 \u7b2c5-6\u7d1a\u7e96\u7dad\u5316(\u56b4\u91cd\u7e96\u7dad\u5316\/\u809d\u786c\u5316)<\/p>\n

\u5c0d\u5927\u591a\u6578\u800c\u8a00\uff0c\u809d\u764c\u662f\u5169\u500b\u75be\u75c5\u5408\u800c\u70ba\u4e00: \u6f5b\u5728\u6027\u809d\u75c5\u548c\u764c\u75c7\u3002\u5c31\u9810\u6e2c\u9810\u5f8c\u800c\u8a00\uff0c\u51fa\u73fe\u809d\u786c\u5316\u53ef\u80fd\u662f\u548cTNM\u5206\u671f\u4e00\u6a23\u91cd\u8981\u6216\u66f4\u91cd\u8981\uff0c\u56e0\u6b64\u50b3\u7d71\u7684TNM\u5206\u671f\u662f\u4e0d\u5920\u7684\uff0c\u56b4\u91cd\u7e96\u7dad\u5316\/\u809d\u786c\u5316\u5c0d\u5b58\u6d3b\u6709\u4e0d\u826f\u7684\u5f71\u97ff\uff0c\u4f46AJCC\u5206\u671f\u592a\u8907\u96dc\u3002<\/p>\n

\u65b0\u7684\u809d\u764c\u5206\u671f\u7cfb\u7d71
\n\u7531\u65bc\u76ee\u524d\u5206\u671f\u7cfb\u7d71\u7684\u56f0\u5883\u7522\u751f\u4e86\u5e7e\u7a2e\u65b0\u7684\u809d\u764c\u5206\u671f\u7cfb\u7d71\u3002\u4ecd\u4e0d\u6e05\u695a\u7fa9\u5927\u5229CLIP\u3001\u9999\u6e2fCUPI\u6216\u5176\u5b83\u7cfb\u7d71\u662f\u5426\u80fd\u63d0\u4f9b\u81e8\u5e8a\u7814\u7a76\u826f\u597d\u7684\u8a2d\u8a08\u6216\u662f\u63d0\u4f9b\u75c5\u4eba\u9069\u7576\u7684\u5206\u985e\u3002<\/p>\n

Cancer of the Liver Italian Program(CLIP) Staging:
\nCLIP\u5206\u671f\u5728\u809d\u764c\u7684\u7fa9\u5927\u5229\u65cf\u7fa4\u662f\u6709\u6548\u7684(Hepatology 2000)\uff0c\u770b\u8d77\u4f86\u6bd4Okuda\u5206\u671f\u7cfb\u7d71\u66f4\u654f\u611f\uff0c\u53ef\u4ee5\u7522\u751f6\u7a2e\u9810\u5f8c\u5206\u7d44(score 0~5)\u3002<\/p>\n

\u6cbb\u7642\u6458\u8981
\n\u624b\u8853\u5207\u9664\u662f\u809d\u764c\u552f\u4e00\u6839\u6cbb\u6027\u7684\u6cbb\u7642\uff0c\u7136\u800c\uff0c\u5927\u591a\u6578\u75c5\u4eba\u5728\u75be\u75c5\u767c\u73fe\u6642\u56e0\u70ba\u809d\u529f\u80fd\u4e0d\u4f73(75%\u4ee5\u4e0a\u7684\u75c5\u4eba\u6709\u6f5b\u5728\u7684\u6162\u6027\u809d\u75c5)\u3001\u5169\u5074\u809d\u8449\u75be\u75c5\u3001\u6216\u809d\u5916\u8f49\u79fb\u800c\u7121\u6cd5\u5207\u9664\u3002\u56e0\u6b64\uff0c\u809d\u764c\u7684\u6574\u9ad4\u53ef\u5207\u9664\u7387\u53ea\u670910~25%\u3002\u5982\u679c\u809d\u764c\u7121\u6cd5\u5207\u9664\uff0c\u9810\u5f8c\u5f88\u5dee\uff0c\u4e2d\u4f4d\u5b58\u6d3b\u671f\u53ea\u6709\u5e7e\u500b\u6708\u3002\u5373\u4f7f\u63a5\u53d7\u624b\u8853\u5207\u9664\u7684\u75c5\u4eba\uff0c5\u5e74\u5fa9\u767c\u7387\u9ad8\u523083%\u3002\u7121\u6cd5\u624b\u8853\u5207\u9664\u6216\u662f\u624b\u8853\u5f8c\u5fa9\u767c\u9069\u5408\u975e\u624b\u8853\u6027\u7684\u6cbb\u7642, \u975e\u624b\u8853\u6027\u6cbb\u7642\u53ef\u4ee5\u662f\u5c40\u90e8\u5340\u57df\u6027\u7684\uff0c\u5305\u62ec\u9152\u7cbe\u6ce8\u5c04(PEI)\u3001\u5c04\u983b\u816b\u7624\u6ec5\u9664\u8853(RFA)\u3001\u6216\u52d5\u8108\u6813\u585e(TAE)\u3002\u7576\u5340\u57df\u6dcb\u5df4\u8f49\u79fb\u6216\u662f\u809d\u5916\u8f49\u79fb\uff0c\u5c40\u90e8\u5340\u57df\u6027\u6cbb\u7642\u5c31\u4e0d\u9069\u5408\uff0c\u7576\u4e3b\u8981\u9580\u8108\u7cfb\u7d71\u53d7\u5230\u4fb5\u72af\u6642\uff0c\u52d5\u8108\u6813\u585e\u4e5f\u4e0d\u9069\u5408\u3002\u5c0d\u7121\u6cd5\u63a5\u53d7\u4e0a\u8ff0\u9019\u4e9b\u6cbb\u7642\u7684\u75c5\u4eba\uff0c\u901a\u5e38\u6703\u8003\u616e\u5168\u8eab\u6027\u5316\u7642\u3002<\/p>\n

\u6839\u6cbb\u6027\u7642\u6cd5(curative treatment)
\n1.\u624b\u8853\u5207\u9664:\u552f\u4e00\u6839\u6cbb\u6027\u7684\u6cbb\u7642\uff0c\u53f0\u7063\u53ef\u5207\u9664\u8005\u7684\u75c5\u4eba\u4e0d\u523010%
\n\uff081\uff09\u90e8\u5206\u809d\u5207\u9664\u7684\u9069\u61c9\u75c7:
\n\u4e00\u822c\u9078\u64c7: non-cirrhotic \u6216 Child-Pugh A (5\u5e74\u5b58\u6d3b30%)\u3002\u4f46\u662f2002\u5e74ASCO\u5efa\u8b70\u6700\u597d\u9078\u64c7\u6c92\u6709\u75c7\u72c0\u3001\u809d\u529f\u80fd\u6b63\u5e38\u7684\u55ae\u4e00\u816b\u7624(< 5\u516c\u5206)\u4ee5\u9054\u5230\u624b\u8853\u6700\u597d\u7684\u6548\u679c\u3002\u809d\u529f\u80fd\u6b63\u5e38\u4e0d\u662f\u7531Child-Pugh\u5206\u985e\u4f86\u8a55\u4f30\uff0c\u6700\u7406\u60f3\u7684\u75c5\u4eba\u662f\u6c92\u6709\u660e\u986f\u9580\u975c\u8108\u9ad8\u58d3\u800c\u4e14\u81bd\u7d05\u7d20\u6b63\u5e38\u7684\u75c5\u4eba\u3002\u9078\u64c7\u9019\u985e\u75c5\u4eba\u4e0d\u6703\u767c\u751f\u624b\u8853\u5f8c\u809d\u8870\u7aed\u548c\u76f8\u95dc\u7684\u6b7b\u4ea1\u7387\uff0c\u9810\u671f\u76845\u5e74\u5b58\u6d3b\u7387\u53ef\u4ee5\u8d85\u904e70%\u3002
\n\uff082\uff09\u624b\u8853\u65b9\u6cd5:
\n\u4e00\u5b9a\u8981\u505a\u624b\u8853\u4e2d\u8d85\u97f3\u6ce2\u4ee5\u5075\u6e2c\u984d\u5916\u7684\u816b\u7624\u75c5\u7076\u548c\u5f15\u5c0e\u89e3\u5256\u5b78\u4e0a\u7684\u5207\u9664(segmentectomy)\u4ee5\u6d88\u9664\u672a\u88ab\u8a8d\u51fa\u7684\u5c40\u90e8\u6563\u4f48\u3002\u624b\u8853\u908a\u7de3\u81f3\u5c11\u89811\u516c\u5206(< 1\u516c\u5206\u6613\u5fa9\u767c)\u3002\u5373\u4f7f\u5982\u6b64\uff0c\u5207\u9664\u5f8c\u7684\u9577\u671f\u7d50\u679c\u88ab\u9ad8\u5fa9\u767c\u7387\u62b5\u6d88(5\u5e74\u5927\u65bc70%)\u3002
\n\uff083\uff09\u624b\u8853\u7d50\u679c:
\n\u975e\u809d\u786c\u5316\u75c5\u4eba\uff0c\u624b\u8853\u6b7b\u4ea1\u7387 < 5%\uff0c5\u5e74\u5b58\u6d3b\u7387 > 30%\u3002
\n\u809d\u786c\u5316\u75c5\u4eba\uff0c\u624b\u8853\u6b7b\u4ea1\u7387 >10%\uff0c\u82e5\u53ef\u5f9e\u624b\u8853\u5b58\u6d3b\u52475\u5e74\u5b58\u6d3b\u738730%\u3002
\n\u809d\u786c\u5316\u75c5\u4eba\u548c\u975e\u809d\u786c\u5316\u75c5\u4eba\u7684\u9577\u671f\u7d50\u679c\u76f8\u4f3c\u3002
\n\uff084\uff09\u524d\u5c0e\u6027\u6216\u8f14\u52a9\u6027\u5316\u7642:
\n\u76ee\u524d\u6c92\u6709\u8cc7\u6599\u5efa\u8b70\u8ffd\u52a0\u4efb\u4f55\u524d\u5c0e\u6027\u6216\u8f14\u52a9\u6027\u5316\u7642\u3002<\/p>\n

2.\u809d\u79fb\u690d(\u5728\u53f0\u7063\u809d\u708e\u76db\u884c, \u4e0d\u592a\u53ef\u884c):
\n\uff081\uff09\u809d\u79fb\u690d\u9069\u61c9\u75c7:
\n\u4e00\u822c\u9078\u64c7: \u91dd\u5c0dChild-Pugh B\u3001C\u548c\u809d\u529f\u80fd\u4e0d\u826f\u3002\u5c0f\u65bc5\u516c\u5206\u7684\u816b\u7624\u9810\u5f8c\u512a\u65bc\u5927\u65bc5\u516c\u5206\u7684\u816b\u7624(55\u500b\u6708 vs 24\u500b\u6708)\uff0c\u56e0\u6b64\u5927\u591a\u6578\u7684\u6a5f\u69cb\u4e0d\u9858\u5c0d\u5927\u65bc5\u516c\u5206\u7684\u816b\u7624\u9032\u884c\u79fb\u690d\u30022002\u5e74ASCO\u5efa\u8b70\u5fc5\u9808\u4fb7\u9650\u5728 < 5\u516c\u5206\u7684\u55ae\u9846\u816b\u7624\u6216 \u22663\u516c\u5206\u76843\u9846\u816b\u7624\uff0c\u9069\u7576\u9078\u64c7\u7684\u75c5\u4eba5\u5e74\u5b58\u6d3b\u7387\u53ef\u4ee5\u9054\u523070%\u800c\u5fa9\u767c\u7387\u4f4e\u65bc15%\uff0c\u4f46\u624b\u8853\u6b7b\u4ea1\u7387\u9ad8\u523020%\u3002<\/p>\n

3.\u9152\u7cbe\u6ce8\u5c04(Ethanol):
\n\uff081\uff09\u900f\u904e\u8a31\u591a\u85e5\u7269\u7684\u816b\u7624\u5167\u6ce8\u5c04\u53ef\u4ee5\u9054\u5230\u816b\u7624\u58de\u6b7b\u3002\u5728\u5c04\u983b\u816b\u7624\u6ec5\u9664\u8853\u51fa\u73fe\u4ee5\u524d\uff0c\u7d93\u76ae\u9152\u7cbe\u6ce8\u5c04(PEI)\u88ab\u5ee3\u6cdb\u63a5\u53d7\u70ba\u6cbb\u7642\u809d\u764c\u6700\u4e0d\u5177\u4fb5\u72af\u6027\u7684\u65b9\u6cd5\uff0c\u5b83\u662f\u5728\u8d85\u97f3\u6ce2\u6216\u96fb\u8166\u65b7\u5c64\u7684\u5c0e\u5f15\u4e0b\u7d93\u76ae\u6ce8\u5c04\u7d14\u5ea695%\u4ee5\u4e0a\u7684\u9152\u7cbe\uff0c\u9152\u7cbe\u5f15\u8d77\u809d\u7d30\u80de\u5167\u7684\u86cb\u767d\u8cea\u51dd\u56fa\u8b8a\u8cea\u800c\u9020\u6210\u809d\u816b\u7624\u7d30\u80de\u7684\u51dd\u56fa\u6027\u58de\u6b7b\u3002\u4e00\u822c\u7d66\u6cd5\uff1a10~20cc tiw x 12\u6b21\uff0c\u6cbb\u7642\u7684\u8010\u53d7\u6027\u826f\u597d\uff0c\u53ef\u4ee5\u6e1b\u8f15\u6cbb\u7642\u8cbb\u7528\u3002
\n\uff082\uff09\u7d93\u76ae\u9152\u7cbe\u6ce8\u5c04\u7684\u9069\u61c9\u75c7:
\n\u4e3b\u8981\u91dd\u5c0d\u5c0f\u65bc2\u516c\u5206\u7684\u55ae\u9846\u816b\u7624\u3001\u9060\u96e2\u809d\u81df\u7a79\u7abf(hepatic dome)\u7684\u75c5\u7076\u3001\u548c\u809d\u529f\u80fd\u4e0d\u826f\u7684\u75c5\u4eba\u3002\u5c0d\u4e0d\u662f\u8840\u7ba1\u8c50\u5bcc(hypovascular)\u7684\u816b\u7624\u6548\u679c\u8f03\u597d(\u52d5\u8108\u6813\u585e\u5247\u5c0d\u591a\u8840\u7ba1\u816b\u7624\u6548\u679c\u8f03\u597d)\u3002Bruix(Hepatology 2002)\u5efa\u8b70\u9152\u7cbe\u6ce8\u5c04\u662f\u4e0d\u9069\u5408\u809d\u79fb\u690d\u75c5\u4eba\u7684\u7b2c\u4e00\u7dda\u6cbb\u7642\u9078\u64c7\u3002\u5927\u65bc3\u516c\u5206\u7684\u75c5\u7076\u5fa9\u767c\u7387\u9ad8\u3001\u65bd\u884c\u671f\u9593\u660e\u986f\u75bc\u75db\u3001\u5fc5\u9808\u91cd\u8907\u6cbb\u7642\uff0c\u56e0\u6b64\u9650\u5236\u4e86\u9019\u500b\u6280\u8853\u7684\u53ef\u7528\u6027\u3002
\n\uff083\uff09\u7d93\u76ae\u9152\u7cbe\u6ce8\u5c04\u7684\u7642\u6548
\n\u5927\u591a\u6578\u7814\u7a76\u5831\u544a\u6cbb\u7642\u52304\u516c\u5206\u7684\u75c5\u7076\u3002\u6cbb\u7642\u7684\u53cd\u61c9\u7387\u53d6\u6c7a\u65bc\u75c5\u7076\u76f4\u5f91\uff0c\u901a\u5e38\u22663\u516c\u5206\u7684\u75c5\u7076\u9054\u5230100%\uff0c\u5c0f\u578b\u816b\u7624\u7684\u5b58\u6d3b\u6700\u597d\u3002Livraghi T(Radiology 1995)\u8b49\u5be6Child-Pugh\u809d\u786c\u5316\u5206\u7d1aA\u3001B\u3001C\u76843\u5e74\u5b58\u6d3b\u7387\u5206\u5225\u662f79%\u300163%\u300112%\uff0c\u5c0d\u65bcChild-Pugh A\u548c\u53ef\u4ee5\u624b\u8853\u5207\u9664\u7684\u75c5\u4eba\uff0c\u624b\u8853\u5207\u9664\u76843\u5e74\u5b58\u6d3b\u7387(79%)\u7a0d\u5fae\u9ad8\u65bc\u7d93\u76ae\u9152\u7cbe\u6ce8\u5c04(71%)\u3002\u7136\u800c\u5c0d\u65bcChild-Pugh B\u7684\u75c5\u4eba\uff0c\u7d93\u76ae\u9152\u7cbe\u6ce8\u5c04\u7684\u5b58\u6d3b\u7387\u6bd4\u624b\u8853\u5207\u9664\u7a0d\u5fae\u597d\u4e00\u4e9b\u3002<\/p>\n

4. \u5c04\u983b\u816b\u7624\u6ec5\u9664\u8853(Radiofrequency ablation\uff0cRFA)
\n\uff081\uff09\u539f\u7406\uff1a
\n\u5c04\u983b\u816b\u7624\u6cbb\u7642\u7684\u539f\u7406\u8207\u4e00\u822c\u96fb\u71d2(electrocautery)\u4e26\u4e0d\u76f8\u540c\uff0c\u76ee\u524d\u5b83\u5df2\u7d93\u5ee3\u6cdb\u5730\u53d6\u4ee3\u7d93\u76ae\u9152\u7cbe\u6ce8\u5c04\u505a\u70ba\u5c40\u90e8\u5340\u57df\u6458\u9664\u6027\u6cbb\u7642\u7684\u9078\u64c7\u3002\u96fb\u71d2\u662f\u5229\u7528\u96fb\u6d41\u901a\u904e\u63a2\u91dd\u524d\u7aef\u7684\u52a0\u71b1\u5668\uff0c\u7531\u96fb\u71d2\u63a2\u91dd\u7684\u5c16\u7aef\u76f4\u63a5\u5c07\u71b1\u50b3\u5c0e\u5230\u5468\u570d\u7684\u7d44\u7e54\uff0c\u800c\u5176\u7d44\u7e54\u7684\u50b7\u5bb3\u5247\u4f9d\u8cf4\u63a2\u91dd\u6240\u91cb\u653e\u51fa\u7684\u71b1\u91cf\u800c\u5b9a\u3002\u5c04\u983b\u6cbb\u7642\u6240\u7528\u7684\u65b9\u5f0f\u6709\u6642\u88ab\u7a31\u4f5c\u51b7\u96fb\u71d2\uff0c\u662f\u5728\u8d85\u97f3\u6ce2\u6307\u5f15\u6216\u96fb\u8166\u65b7\u5c64\u6307\u5f15\u4e0b\uff0c\u5c07\u6cbb\u7642\u63a2\u91dd(probe)\u7a7f\u904e\u76ae\u819a\uff0c\u63d2\u5165\u816b\u7624\u7d44\u7e54\u4e2d\uff0c\u7136\u5f8c\u63a5\u4e0a\u96fb\u6e90\u653e\u51fa\u4ea4\u6d41\u96fb\uff0c\u7576\u4ea4\u6d41\u96fb\u7d93\u904e\u7d44\u7e54\u6642\uff0c\u4f7f\u5f97\u7d44\u7e54\u7576\u4e2d\u7684\u96fb\u5b50\u88ab\u6fc0\u76ea\uff0c\u7576\u96fb\u5b50\u5faa\u8457\u96fb\u6d41\u65b9\u5411\u7684\u6539\u8b8a\u800c\u524d\u9032\u6642\uff0c\u96fb\u5b50\u6fc0\u76ea\u9020\u6210\u4e86\u5c0d\u5305\u570d\u5728\u96fb\u6975\u5468\u570d\u7684\u7d44\u7e54\u7522\u751f\u4e86\u6469\u64e6\u71b1\u3002\u9019\u500b\u904e\u7a0b\u6703\u7522\u751f\u9ad8\u71b1\uff0c\u96fb\u6975\u672c\u8eab\u4e26\u4e0d\u7522\u751f\u71b1\u91cf\uff0c\u800c\u53ea\u6709\u7d44\u7e54\u88ab\u52a0\u71b1\uff0c\u4e0d\u904e\u7d44\u7e54\u53ef\u5c07\u4e00\u90e8\u4efd\u71b1\u50b3\u5c0e\u56de\u63a2\u91dd\uff0c\u7576\u7d44\u7e54\u63a5\u53d7\u4e86\u8db3\u5920\u91cf\u7684\u71b1\u5ea6\u9054\u5230\u651d\u6c0f50-100\u2103\u6642\uff0c\u53d7\u6cbb\u7642\u7684\u7d44\u7e54\u6703\u7522\u751f\u51dd\u56fa\u6027\u58de\u6b7b(coagulation necrosis)\uff0c\u56e0\u6b64\u50cf\u86cb\u88ab\u52a0\u71b1\u4e00\u6a23\uff0c\u764c\u7d30\u80de\u4fbf\u88ab\u56fa\u5b9a\u800c\u6b7b\u4ea1\u3002
\n\uff082\uff09\u512a\u9ede\uff1a
\n\u9019\u7a2e\u6cbb\u7642\u65b9\u5f0f\u7684\u512a\u9ede\u662f\u50b7\u53e3\u5c0f\uff0c\u6cbb\u7642\u6642\u9593\u77ed\uff0c\u53ef\u4ee5\u4e00\u6b21\u5c07\u816b\u7624\u7d44\u7e54\u5b8c\u5168\u6bba\u6b7b\uff0c\u505a\u5b8c\u6cbb\u7642\u5f8c\u82e5\u6c92\u6709\u767c\u751f\u4f75\u767c\u75c7\uff0c24\u5c0f\u6642\u5167\u5373\u53ef\u51fa\u9662\uff0c\u7e2e\u77ed\u4f4f\u9662\u5929\u6578\u3002
\n\uff083\uff09\u5c04\u983b\u6cbb\u7642\u7684\u7f3a\u9ede\u53ca\u9650\u5236\uff1a
\n\u5c04\u983b\u6cbb\u7642\u7528\u65bc\u809d\u786c\u5316\u75c5\u4eba\u6216\u8005\u816b\u7624\u9760\u8fd1\u4e3b\u8981\u7684\u81bd\u9053\u7cfb\u7d71\u6642\uff0c\u90fd\u8981\u7279\u5225\u8b39\u614e\u3002\u7576\u816b\u7624\u5f88\u9760\u8fd1\u809d\u81df\u8868\u9762\uff0c\u4f4d\u65bc\u809d\u81df\u5305\u819c\u4e4b\u4e0b(subcapsular tumor)\u6642\uff0c\u5c04\u983b\u6cbb\u7642\u7684\u904e\u7a0b\u4e2d\u767c\u751f\u51fa\u8840\u7684\u6a5f\u6703\u8f03\u9ad8\uff0c\u53ef\u80fd\u4fc3\u9032\u8179\u819c\u5167\u816b\u7624\u6563\u4f48\u3002\u5c0d\u65bc\u5927\u8840\u7ba1\u65c1\u7684\u816b\u7624\uff0c\u5c04\u983b\u6cbb\u7642\u82e5\u4ee5\u7d93\u76ae\u6cbb\u7642\u7684\u65b9\u5f0f\uff0c\u5247\u9760\u5927\u8840\u7ba1\u65c1\u7684\u816b\u7624\u7d30\u80de\u56e0\u8840\u7ba1\u7684\u51b7\u537b\u6548\u61c9\u800c\u4f7f\u6eab\u5ea6\u63d0\u5347\u4e0d\u8db3\uff0c\u6bba\u6ec5\u816b\u7624\u7684\u80fd\u529b\u4fbf\u6703\u6e1b\u5f31\uff0c\u53ef\u80fd\u5c0e\u81f4\u6cbb\u7642\u4e0d\u5b8c\u5168\u3002\u5982\u679c\u816b\u7624\u5f88\u9760\u8fd1\u4e2d\u7a7a\u81df\u5668\uff0c\u7a4d\u6975\u7684\u6cbb\u7642\u6216\u8a31\u6703\u5c0e\u81f4\u8178\u7ba1\u6216\u4e2d\u7a7a\u81df\u5668\u7684\u7a7f\u5b54\u3002\u51fa\u8840\u662f\u6700\u5e38\u898b\u7684\u4f75\u767c\u75c7\uff0c\u5728\u5c04\u983b\u7684\u96fb\u6975\u91dd\u62d4\u51fa\u5f8c\uff0c\u96fb\u6975\u91dd\u7a7f\u904e\u7d44\u7e54\u4e4b\u901a\u9053\u51fa\u8840\u7684\u6a5f\u6703\u53ef\u905429.8%\uff0c\u4f46\u51fa\u8840\u91cf\u90fd\u5f88\u5c11(\u5c0f\u65bc5CC)\u3002
\n\uff084\uff09RFA\u7684\u9069\u61c9\u75c7:<\/p>\n

2002\u5e74ASCO\u6307\u51fa: \u5c0d\u22663\u516c\u5206\u7684\u816b\u7624\u6548\u679c\u9152\u7cbe\u6ce8\u5c04\u4e00\u6a23\u3002\u5c0d3\u516c\u5206\u4ee5\u4e0a\u7684\u816b\u7624\u5b8c\u5168\u53cd\u61c9\u7387\u4e0d\u523050%, \u56e0\u6b64\u9019\u6a23\u5927\u5c0f\u7684\u816b\u7624\u6548\u679c\u4e0d\u5982\u624b\u8853\u5207\u9664\u3002<\/p>\n

\uff085\uff09RFA\u7684\u7642\u6548\uff1a<\/p>\n

Tanabe KK(Cancer 2004)\u5831\u544a\u7684\u6700\u597d\u7642\u6548\u662f\u5c0f\u65bc4\u516c\u5206\u7684\u55ae\u4e00\u816b\u7624\u3002 Sironi S(Am J Roentgenol 1999)\u8b49\u5be6\u816b\u7624\u5927\u5c0f\u52302\u516c\u5206\u7684\u75c5\u4eba\uff0c\u5b8c\u5168\u53cd\u61c9\u7387\u670985%\u3002<\/p>\n

\uff086\uff09RFA\u548cPEI\u4f55\u8005\u8f03\u597d\uff1f<\/p>\n

Lin SM(Gastroenterology 2004)\u5c07\u22664\u516c\u5206\u7684\u816b\u7624\u96a8\u6a5f\u5206\u6210RFA\u6216PEI\uff0c\u7d50\u679cRFA\u7684\u5c40\u90e8\u816b\u7624\u60e1\u5316\u7387\u3001\u6574\u9ad4\u5b58\u6d3b\u7387\u3001\u548c\u7121\u764c\u75c5\u5b58\u6d3b\u7387\u90fd\u512a\u65bcPEI\u3002<\/p>\n

\uff087\uff09RFA\u548c\u624b\u8853\u4f55\u8005\u8f03\u597d\uff1f<\/p>\n

Montorsi M(J Gastrointest Surg 2005)\u5728\u5c0f\u65bc5\u516c\u5206\u7684\u55ae\u4e00\u816b\u7624\u6bd4\u8f03\u624b\u8853\u5207\u9664\u548cRFA\uff0c\u5169\u8005\u57284\u5e74\u5b58\u6d3b\u7387\u6c92\u6709\u5dee\u5225\uff0c\u4f46RFA\u7684\u5fa9\u767c\u7387\u8f03\u9ad8\u3002<\/p>\n

\uff088\uff09RFA\u6cbb\u7642\u5f8c\u7684\u8ffd\u8e64\u4e00\u822c\u662f\u505a\u5b8c\u6cbb\u7642\u7684\u4e00\u500b\u6708\u5f8c\uff0c\u4ee5\u96fb\u8166\u65b7\u5c64\u6aa2\u67e5\u70ba\u4e3b\uff0c\u6709\u6642\u5019\u4e5f\u53ef\u4ee5\u4f7f\u7528\u8d85\u97f3\u6ce2\u6216\u78c1\u632f\u9020\u5f71\u7684\u65b9\u5f0f\u8ffd\u8e64\uff1b\u82e5\u662f\u592a\u65e9\u8ffd\u8e64\u7684\u8a71\uff0c\u6aa2\u67e5\u51fa\u4f86\u7684\u5f71\u50cf\u4e0d\u5bb9\u6613\u5340\u5206\u7a76\u7adf\u662f\u6b98\u5b58\u7684\u816b\u7624\u6216\u662f\u6cbb\u7642\u5f8c\u767c\u751f\u7684\u8b8a\u5316\u3002\u5047\u5982\u4ecd\u6709\u6b98\u5b58\u6216\u5fa9\u767c\u7684\u816b\u7624\u53ef\u4ee5\u63a5\u53d7\u7b2c\u4e8c\u6b21\u7684\u6cbb\u7642\u3002\u5982\u679c\u53c8\u6709\u65b0\u9577\u51fa\u7684\u816b\u7624\uff0c\u4ecd\u53ef\u91cd\u8986\u61c9\u7528\u6b64\u6cd5\u518d\u4f5c\u6cbb\u7642\u3002<\/p>\n

\u7de9\u548c\u6027\u7642\u6cd5(palliative treatment)<\/p>\n

1.\u7d93\u52d5\u8108(\u5316\u7642)\u6813\u585e[Trans-arterial (chemo)embolization, TAE\/TACE]<\/p>\n

\uff081\uff09\u7d93\u52d5\u8108\u6813\u585e\u4f7f\u7528Gelatin(\u4e00\u7a2e\u53ef\u6eb6\u6027\u6813\u585e\u7269)\u6216Ivalon(\u4e00\u7a2e\u6c38\u4e45\u4e0d\u6eb6\u6027\u6813\u585e\u7269)\u7b49\u7684\u6813\u585e\u5291(embolizer)\u6ce8\u5c04\u5230\u4f9b\u61c9\u816b\u7624\u7684\u809d\u52d5\u8108\u5206\u652f(TAE)\uff0c\u6216\u8005\u518d\u9644\u52a0\u6ce8\u5c04\u548c\u6cb9\u6027\u7898(lipiodol)\u6df7\u5408\u5728\u4e00\u8d77\u7684\u5316\u7642\u85e5\u7269(TACE)\u3002\u5ee3\u6cdb\u61c9\u7528\u7684\u55ae\u4e00\u5316\u7642\u85e5\u7269\u662fdoxorubicin\uff0c\u7f8e\u570b\u504f\u597d\u5c07cisplatin\u3001doxorubicin\u548cmitomycin C\u4f75\u7528\u3002<\/p>\n

\uff082\uff09\u7d93\u52d5\u8108(\u5316\u7642)\u6813\u585e\u7684\u9069\u61c9\u75c7:<\/p>\n

\u7121\u6cd5\u624b\u8853\u5207\u9664\u7684\u809d\u764c\u7684\u7de9\u548c\u6027\u6cbb\u7642\uff1a\u4e3b\u8981\u7684\u76ee\u7684\u662f\u6e1b\u8f15\u75bc\u75db\uff0c65%\u6709\u6548\u3002<\/p>\n

\u809d\u81df\u5207\u9664\u7684\u8f14\u52a9\u7642\u6cd5(adjunctive therapy)\uff0c\u7232\u7b49\u5f85\u809d\u81df\u79fb\u690d\u7684\u60a3\u8005\u505a\u6e96\u5099(bridge to liver transplantation)\u548c\u5c04\u983b\u816b\u7624\u6ec5\u9664\u8853(RFA)\u5408\u4f75\u4f7f\u7528<\/p>\n

\uff083\uff09\u7d93\u52d5\u8108(\u5316\u7642)\u6813\u585e\u7684\u7981\u5fcc\u75c7:<\/p>\n

\u9580\u975c\u8108\u6813\u585e\u6216Child’s C\u6216\u809d\u786c\u5316\u3002<\/p>\n

\uff084\uff09\u7d93\u52d5\u8108\u6813\u585e\u7684\u6548\u679c:<\/p>\n

\u6700\u521d\u7684\u5927\u578b\u96a8\u6a5f\u7814\u7a76\u6bd4\u8f03TAE\/TACE(cisplatin\u6216doxorubicin)\u6216\u652f\u6301\u6027\u7642\u6cd5\uff0c\u90fd\u78ba\u8a8dTAE\/TACE\u7684\u6297\u816b\u7624\u6548\u679c\uff0c\u4f46\u7121\u6cd5\u8b49\u660e\u8b49\u660e\u5c0d\u5b58\u6d3b\u6709\u5e6b\u52a9\u3002<\/p>\n

Lo CM(Hepatology 2002)\u548cLlovet JM(Lancet 2002)\u7684\u96a8\u6a5f\u7814\u7a76\u5247\u6307\u51faTACE\u5c0d\u67d0\u4e9b\u809d\u529f\u80fd\u6b63\u5e38\u7684\u75c5\u4eba\u6709\u5b58\u6d3b\u5e6b\u52a9\u3002Llovet JM(Lancet 2003)\u5c0d7\u500b\u52d5\u8108\u6813\u585e\u7684\u96a8\u6a5f\u7814\u7a76\u9032\u884c\u591a\u91cd\u5206\u6790\uff0c\u986f\u793aTACE\u80fd\u6539\u55842\u5e74\u5b58\u6d3b\u7387(odds ratio=0.53)\uff0c\u4e2d\u4f4d\u5b58\u6d3b\u671f\u53ef\u4ee5\u8d85\u904e2\u5e74\uff0c\u4e0d\u904e\u5f88\u5c11\u80fd\u5c07\u75c5\u4eba\u8f49\u8b8a\u6210\u53ef\u80fd\u624b\u8853\u5207\u9664\u3002<\/p>\n

\uff085\uff09\u6700\u8fd1\u722d\u8b70\u9ede\uff1a<\/p>\n

\u6700\u521d\u5c0d\u52d5\u8108\u9589\u585e\u7684\u60f3\u6cd5\u662f\u5f15\u8d77\u816b\u7624\u5167\u90e8\u7f3a\u8840\uff0c\u85c9\u7531\u6539\u8b8a\u4f4d\u65bc\u7d30\u80de\u8868\u9762\u7684\u5e6b\u6d66\u5141\u8a31\u8f03\u591a\u7684\u5316\u7642\u85e5\u7269\u9032\u5165\u764c\u7d30\u80de\u800c\u9054\u5230\u8f03\u9ad8\u7684\u816b\u7624\u53cd\u61c9\u3002\u7136\u800c\uff0c\u8a31\u591a\u6700\u8fd1\u7684\u7814\u7a76\u537b\u6307\u51fa\u816b\u7624\u7f3a\u8840\u7684\u58de\u8655\u591a\u65bc\u597d\u8655\uff0c\u56e0\u70ba\u5b83\u6703\u76f4\u63a5\u523a\u6fc0\u8840\u7ba1\u65b0\u751f\u3001\u816b\u7624\u4fb5\u72af\u3001\u816b\u7624\u4ee3\u8b1d\uff0c\u4e5f\u6703\u5c0d\u7d30\u80de\u51cb\u4ea1\u7522\u751f\u6297\u6027\u3002<\/p>\n

2.\u52d5\u8108\u5167\u5316\u7642(Intra-arterial CT): \u63d0\u9ad8\u53cd\u61c9\u7387\u4f46\u6c92\u6709\u5b58\u6d3b\u5e6b\u52a9\u52d5\u8108\u5167\u5316\u7642\u53ef\u63d0\u9ad8\u85e5\u7269\u66b4\u9732400\u500d\u3002\u4f46\u82e5\u85e5\u7269\u5f9e\u5168\u8eab\u6027\u975c\u8108\u6ce8\u5c04\u8f03\u6709\u6548, \u5247\u4e0d\u8a72\u505a\u52d5\u8108\u5167\u5316\u7642\u3002\u6709\u4eba\u7814\u7a76\u52d5\u8108\u5167FLAP(FUDR+LV+ADR+CDDP)\u53cd\u61c9\u7387 > 40%, \u5c1a\u672a\u9054\u5230\u4e2d\u4f4d\u5b58\u6d3b\u671f\u3002<\/p>\n

3.\u5168\u8eab\u6027\u5316\u7642\uff1a\u6c92\u6709\u6709\u6548\u7684\u5316\u7642\uff0c\u6c92\u6709\u6a19\u6e96\u5316\u7642\u3002
\n\uff081\uff09\u6c92\u6709\u8b49\u64da\u6307\u51fa\u5316\u7642\u53ef\u4ee5\u5ef6\u9577\u5b58\u6d3b\uff0cdoxorubicin\u548cepirubicin\u662f\u6700\u5e38\u88ab\u7814\u7a76\u7684\u85e5\u7269\uff0c\u55ae\u4e00\u85e5\u7269\u53cd\u61c9\u7387\u5927\u7d0410~15%\uff0c\u4f75\u7528\u5176\u5b83\u5316\u7642\u85e5\u7269\u53cd\u61c9\u7387\u589e\u52a0\u523020~35%\u5176\u5b83\u820a\u4e00\u4ee3(5-FU\u3001cisplatin\u3001etoposide\u3001mitoxantrone\u3001vinblastine)\u7684\u5316\u7642\u85e5\u7269\u548c\u65b0\u4e00\u4ee3(capecitabine\u3001gemcitabine\u3001irinotecan\u3001paclitaxel)\u7684\u5316\u7642\u85e5\u7269\u90fd\u4e0d\u80fd\u986f\u793a\u4efb\u4f55\u8f03\u597d\u7684\u53cd\u61c9\u7387\u3002
\n\uff082\uff09\u50b3\u7d71\u5c0d\u5316\u7642\u53cd\u61c9\u7387\u8a55\u4f30\u7684\u6a19\u6e96\u5c0d\u809d\u764c\u4e0d\u9069\u7528, \u53cd\u800c\u5b58\u6d3b\u671f\u8f03\u6709\u7528,\u7121\u6cd5\u5207\u9664\u8005\u7684\u4e2d\u4f4d\u5b58\u6d3b\u671f\u662f6\u500b\u6708\u3002<\/p>\n

4.\u6a19\u9776\u6cbb\u7642\uff1a
\n\uff081\uff09Bevacizumab(Avastin\u2122 )\uff1aSchwartz JD(Proc ASCO 2004)\uff1a\u53cd\u61c9\u7387\u53ea\u67098%\u3002
\n\uff082\uff09Erlotinib(Tarceva\u2122)\uff1aPhilip PA(Proc ASCO 2004)\uff1a\u53cd\u61c9\u7387\u53ea\u670910%\u3002
\n\uff083\uff09Thalidomide(Thado)\uff1aSchwartz JD(Proc ASCO 2003)\uff1a\u53cd\u61c9\u7387\u53ea\u67096%\u3002<\/p>\n

5.\u8377\u723e\u8499\u6cbb\u7642\uff1a
\nGrimaldi(JCO 1998): \u7537\u6027\u8377\u723e\u8499\u5c0d\u7121\u6cd5\u5207\u9664\u7684\u809d\u764c\u6c92\u6709\u4f5c\u7528\u3002
\nBruix(Hepatology 2002): tamoxifen\u5c0d\u665a\u671f\u809d\u764c\u6c92\u6709\u4efb\u4f55\u5e6b\u52a9\u3002<\/p>\n

\u81ea\u767c\u6027\u7834\u88c2
\n\u809d\u764c\u7684\u81ea\u767c\u6027\u7834\u88c2\u662f\u6700\u60b2\u6158\u7684\u81e8\u5e8a\u8868\u73fe\uff0c\u767c\u751f\u7387\u6709\u5730\u57df\u6027\u7684\u5dee\u7570\u3002\u9999\u6e2f\u7684\u767c\u751f\u738714.5%\u3002\u5728\u65e5\u672c\uff0c\u81ea\u767c\u6027\u7834\u88c2\u4f54\u4e86\u6240\u6709\u809d\u764c\u6b7b\u4ea1\u539f\u56e0\u768410%\u3002\u76f8\u53cd\u5730\uff0c\u5728\u897f\u65b9\u570b\u5bb6\u7684\u767c\u751f\u7387\u76f8\u7576\u4f4e\uff0c\u5728\u82f1\u570b\u7684\u767c\u751f\u7387\u4e0d\u52303%\u3002\u91ab\u5e2b\u9762\u5c0d\u9019\u500b\u4f75\u767c\u75c7\u5e38\u89ba\u5f97\u7121\u52a9\uff0c\u9999\u6e2f\u746a\u8389\u7687\u540e\u91ab\u9662\u57282001\u5e74\u767c\u8868\u4ed6\u5011\u5c0d\u81ea\u767c\u6027\u7834\u88c2\u7d93\u9a57\u7684\u56de\u9867\uff0c30\u5929\u7684\u6b7b\u4ea1\u7387\u662f38%\uff0c\u4e2d\u4f4d\u5b58\u6d3b\u671f\u53ea\u67098.9\u661f\u671f\u3002\u63a5\u53d7\u809d\u5207\u9664\u75c5\u4eba\u7684\u5b58\u6d3b\u671f25.7\u500b\u6708\uff0c\u4e0d\u9069\u5408\u63a5\u53d7\u809d\u5207\u9664\u800c\u63a5\u53d7\u809d\u52d5\u8108\u5316\u7642\u6813\u585e\u75c5\u4eba\u7684\u5b58\u6d3b\u671f9.7\u500b\u6708\u3002<\/p>\n

Lai ECS(1990)\u66fe\u6307\u51fa\u81ea\u767c\u6027\u7834\u88c2\u4e0d\u6703\u5f71\u97ff\u6839\u9664\u6027\u5207\u9664\u7684\u5b58\u6d3b\u7d50\u679c, \u7136\u800c\u9019\u500b\u7814\u7a76\u6307\u51fa\u81ea\u767c\u6027\u7834\u88c2\u5f8c\u63a5\u53d7\u809d\u5207\u9664\u7684\u5b58\u6d3b\u6bd4\u6c92\u6709\u767c\u751f\u81ea\u767c\u6027\u7834\u88c2\u7684\u75c5\u4eba\u5dee(25.7\u500b\u6708 vs 49.2\u500b\u6708), \u96d6\u7136\u6b63\u78ba\u539f\u56e0\u4e0d\u660e, \u6211\u5011\u53ef\u4ee5\u89c0\u5bdf\u5230\u81ea\u767c\u6027\u7834\u88c2\u809d\u764c\u7684\u816b\u7624\u9ad4\u7a4d\u660e\u986f\u8f03\u5927\u800c\u4e14\u8f03\u5e38\u898b\u809d\u81df\u5916\u5fa9\u767c\u3002<\/p>\n

\u9810\u5f8c\u56e0\u5b50
\n\u9999\u6e2f\u746a\u8389\u7687\u540e\u91ab\u9662\u57282001\u5e746\u6708\u7684JCO\u767c\u8868\u4ed6\u5011\u5c0d230\u4f4d\u63a5\u53d7\u6839\u9664\u6027\u5207\u9664\u7684\u809d\u764c\u6240\u9032\u884c\u7684\u524d\u77bb\u6027\u7814\u7a76\u4f86\u5206\u6790\u9577\u671f\u5b58\u6d3b(>5\u5e74)\u75c5\u4eba\u7684\u9810\u5f8c\u56e0\u5b50, 5\u5e74\u7684\u7121\u75c5\u5b58\u6d3b\u7387\u662f20%, 5\u5e74\u7684\u6574\u9ad4\u5b58\u6d3b\u7387\u662f37%\u3002
\n\u75c5\u7406\u6027\u5206\u671f(pTNM stage)\u662f\u552f\u4e00\u5c0d\u5b58\u6d3b\u7387\u548c\u7121\u75c5\u5b58\u6d3b\u7387\u90fd\u6709\u610f\u7fa9\u7684\u9810\u6e2c\u56e0\u5b50\u3002<\/p>\n

\u5371\u96aa\u56e0\u5b50
\n1.\u809d\u708e\u75c5\u6bd2\u611f\u67d3(B\u578b\u809d\u708e\u548c\u809d\u786c\u5316\u7684\u91cd\u8981\u6027)
\nBeasley :\u524d\u77bb\u6027\u7814\u7a7622107\u4f4d40~60\u6b72\u7684\u4e2d\u570b\u7537\u6027<\/p>\n

\u5148\u524dB\u578b\u809d\u708e\u75c5\u6bd2\u611f\u67d3(-), \u809d\u786c\u5316(-): \u809d\u764c\u6bcf\u5e74\u767c\u751f\u73870.003%<\/p>\n

\u5148\u524dB\u578b\u809d\u708e\u75c5\u6bd2\u611f\u67d3(+), \u809d\u786c\u5316(-): \u809d\u764c\u6bcf\u5e74\u767c\u751f\u73870.5%<\/p>\n

\u5148\u524dB\u578b\u809d\u708e\u75c5\u6bd2\u611f\u67d3(+), \u809d\u786c\u5316(+): \u809d\u764c\u6bcf\u5e74\u767c\u751f\u73872.4%<\/p>\n

= \u53f0\u7063B\u578b\u809d\u708e\u5e36\u539f\u7684\u7537\u6027, \u6bcf10\u842c\u4eba\u6709495\u4eba\u5f97\u809d\u764c<\/p>\n

*\u75c5\u6bd2\u6027\u809d\u708e\u611f\u67d3\u7684\u53ef\u80fd\u8def\u5f91:<\/p>\n

\u5728\u4e9e\u6d32, B\u578b\u809d\u708e\u611f\u67d3\u7684\u4e3b\u8981\u6a21\u5f0f\u662f\u5468\u7522\u671f(perinatal)\u7684\u6bcd\u5b30\u5782\u76f4\u611f\u67d3\u3002\u5e36\u539f\u6bcd\u89aa\u6240\u751f\u4e4b\u65b0\u751f\u5152\u670940%\u7684\u6a5f\u6703\u906d\u53d7B\u578b\u809d\u708e\u75c5\u6bd2\u611f\u67d3,\u800c\u65b0\u751f\u5152\u5728\u611f\u67d3\u75c5\u6bd2\u5f8c\u6709\u4e5d\u6210\u4ee5\u4e0a\u6703\u6210\u70ba\u5e36\u539f\u8005\u3002<\/p>\n

*\u5f9e\u75c5\u6bd2\u6027\u809d\u708e\u767c\u5c55\u5230\u809d\u764c\u7684\u53ef\u80fd\u904e\u7a0b:<\/p>\n

\u56e0B\u578b\u809d\u708e\u75c5\u6bd2\u7684\u67d3\u8272\u9ad4\u7d44(genome)\u5d4c\u5165\u5bbf\u4e3b\u67d3\u8272\u9ad4,\u4f7f\u809d\u7d30\u80de\u7e7c\u7e8c\u7522\u751fHBsAg \u2192 \u75c5\u4eba\u5bb9\u6613\u8b8a\u6210\u809d\u786c\u5316\u2192 \u518d\u7d93\u904e\u4e00\u9023\u4e32\u57fa\u56e0\u548c\u74b0\u5883\u7684\u523a\u6fc0\u2192 \u8b8a\u6210\u809d\u764c\u3002\u53f0\u7063\u5f9e1984\u5168\u9762\u63a5\u7a2e\u4f7f\u5152\u7ae5HBsAg\u611f\u67d3\u7387\u753110.5%\u4e0b\u964d\u5230\u52301.7%\u30021997\u5e74\u53f0\u5927\u91ab\u5b78\u9662\u5f35\u7f8e\u60e0\u7b49\u4eba\u5728\u4e00\u9805\u63a2\u8a0eB\u578b\u809d\u708e\u75ab\u82d7\u63a5\u7a2e\u5c0d\u5152\u7ae5\u809d\u764c\u767c\u751f\u7387\u7684\u7814\u7a76\u767c\u73fe, B\u578b\u809d\u708e\u75ab\u82d7\u63a5\u7a2e\u8a08\u756b\u5f8c\uff0c\u6211\u570b\u5152\u7ae5\u809d\u764c\u767c\u751f\u7387\u5df2\u4e0b\u964d\u3002<\/p>\n

2. \u809d\u786c\u5316
\n\uff081\uff0980%\u7684\u809d\u764c\u75c5\u4eba\u6709\u809d\u786c\u5316: \u4ecd\u4e0d\u6e05\u695a\u662f\u809d\u786c\u5316\u672c\u8eab\u5f15\u8d77\u809d\u764c,\u6216\u662f\u5f15\u8d77\u809d\u786c\u5316\u7684\u539f\u56e0\u624d\u662f\u81f4\u764c\u56e0\u5b50\u3002
\n\uff082\uff09\u9ad8\u767c\u751f\u7387\u5340: \u5e7e\u4e4e\u6240\u6709\u7684\u809d\u786c\u5316\u90fd\u662fHBV\u5f15\u8d77\u7684macronodular\uff0c\u9ad8\u767c\u751f\u7387\u5340\u809d\u786c\u5316\u6709 \u2267 50%\u8b8a\u6210\u809d\u764c\uff0c\u4f4e\u767c\u751f\u7387\u5340\u67094% \u8b8a\u6210\u809d\u764c\u3002<\/p>\n

\u4f46\u6709\u4e9b\u4e0b\u5217\u60c5\u6cc1\u5247\u767c\u751f\u7387\u589e\u52a0:
\n20% risk for untreated hemochromatosois(\u8840\u8272\u7d20\u6c89\u8457\u75c7) with cirrhosis 40% risk in cirrhosis related to \u03b11-antitrypsin deficiency\u3002<\/p>\n

3.\u809d\u6bd2\u7d20(Hepatotoxin)\uff1a
\n\uff081\uff09\u9ec3\u9eb4\u6bd2\u7d20(aflatoxin)\u7531\u9ec3\u9eb4\u83cc(Aspergillus flavus)\u548c\u76f8\u95dc\u9ef4\u83cc\u7522\u751f\uff0c \u5728\u52d5\u7269\u662f\u5f37\u529b\u81f4\u764c\u7269; \u5728\u4e9e\u6d32\u56e0\u98df\u7269\u5132\u5b58\u65b9\u5f0f, \u5b83\u4e5f\u662f\u4e3b\u8981\u81f4\u75c5\u56e0\u5b50\u3002Ross(1992)\u6307\u51fa\u5c3f\u6db2\u4e2d\u51fa\u73fe\u9ec3\u9eb4\u6bd2\u7d20\u800c\u4e14HBsAg(+)\u7684\u75c5\u4eba\u5f97\u5230\u809d\u764c\u7684\u76f8\u5c0d\u5371\u96aa\u6027\u662f59\uff0c\u7b2c\u4e00\u6b21\u8a3c\u660eHBV\u548c\u9ec3\u9eb4\u6bd2\u7d20\u7684\u66b4\u9732\u5c0d\u809d\u764c\u6709\u52a0\u4e58\u95dc\u4fc2\uff0c\u5c3f\u4e2d\u51fa\u73feaflatoxin-nucleic acid adduct\u589e\u52a02~3\u500d\u7684\u5371\u96aa\u6027\uff0c\u76e3\u6e2c\u9019\u500b\u751f\u7269\u6a19\u8a18\u7684\u6fc3\u5ea6\u5728\u8a55\u4f30\u500b\u4eba\u5371\u96aa\u6027\u53ef\u80fd\u975e\u5e38\u6709\u7528\u3002
\n\uff082\uff09\u6c2f\u4e59\u70ef(vinyl chloride)\u548c\u7837(arsenic):\u809d\u81df\u7684\u8840\u7ba1\u8089\u7624(angiosarcoma)\uff083\uff09\u4e8c\u6c27\u5316\u91f7(\u986f\u5f71\u5291\u7684\u4e00\u7a2e):angiosarcoma,hepatoma,Cholangiocarcinoma
\n\uff084\uff09\u53e3\u670d\u907f\u5b55\u85e5\u548c\u7537\u6027\u8377\u723e\u8499: \u809d\u81df\u817a\u7624(adenoma)
\n\u81f3\u5c11\u6709\u4e00\u500b\u6848\u4f8b\u70ba\u4e86\u5065\u7f8e\u7684\u76ee\u7684\u4f7f\u7528\u808c\u8089\u589e\u5f37\u5291(anabolic steroid)\u800c\u767c\u751f\u809d\u764c\u3002\u53e3\u670d\u907f\u5b55\u85e5\u5f8c\u5f97\u5230\u809d\u764c\u7684\u6848\u4f8b\u4e5f\u66fe\u5831\u544a\u904e\u3002\u96d6\u7136estrogen\u53ef\u4ee5\u5728\u9f67\u9f52\u52d5\u7269(rodent)\u5f15\u8d77\u809d\u764c, \u4f46\u5728\u4eba\u985e\u6d41\u884c\u75c5\u5b78\u7684\u95dc\u806f\u5f9e\u672a\u88ab\u6e05\u695a\u5730\u8b49\u5be6\u3002
\n\uff085\uff09\u9152\u7cbe\u6feb\u7528(alcohol abuse):
\n\u9152\u7cbe\u96d6\u7136\u4e0d\u662f\u81f4\u764c\u7269, \u4f46\u662f\u5c0dB\u578b\u53caC\u578b\u809d\u708e\u75c5\u6bd2\u81f4\u764c\u6027\u6709\u52a0\u6210\u4f5c\u7528\u3002\u800c\u4e14\u9157\u9152\u8005\u5bb9\u6613\u767c\u751f\u809d\u786c\u5316, \u767c\u751f\u809d\u764c\u7684\u6a5f\u6703\u4e5f\u8ddf\u8457\u63d0\u9ad8\u3002<\/p>\n

4.\u7537\u6027\u8f03\u666e\u53ca: \u70ba\u4ec0\u9ebc\u7537\u6027\u9060\u6bd4\u5973\u6027\u5e38\u898b, \u4ecd\u4e0d\u6e05\u695a
\n\uff081\uff09\u662f\u5426\u8207\u751f\u6d3b\u65b9\u5f0f\u6709\u95dc? \u5982\u7537\u4eba\u559d\u9152\u591a
\n\uff082\uff09\u662f\u5426\u8207\u6027\u8377\u723e\u8499\u7684\u65b0\u9673\u4ee3\u8b1d\u6709\u95dc?<\/p>\n

\u53c3\u8003\u8cc7\u6599:<\/p>\n

\u53f0\u7063\u809d\u75c5\u9632\u6cbb\u57fa\u91d1\u6703 \u9673\u5065\u5f18\u91ab\u5e2b\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

\u809d\u764c\u5728\u53f0\u7063 – \u6797\u656c\u658c\u91ab\u5e2b \u6d41\u884c\u75c5\u5b78 \u4e00\u3001\u767c\u751f\u7387\u53ca\u76db\u884c\u7387 \u809d\u7d30\u80de\u764c … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":8,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-168","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/web.csh.org.tw\/web\/224020\/index.php?rest_route=\/wp\/v2\/pages\/168"}],"collection":[{"href":"https:\/\/web.csh.org.tw\/web\/224020\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/web.csh.org.tw\/web\/224020\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/web.csh.org.tw\/web\/224020\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/web.csh.org.tw\/web\/224020\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=168"}],"version-history":[{"count":2,"href":"https:\/\/web.csh.org.tw\/web\/224020\/index.php?rest_route=\/wp\/v2\/pages\/168\/revisions"}],"predecessor-version":[{"id":170,"href":"https:\/\/web.csh.org.tw\/web\/224020\/index.php?rest_route=\/wp\/v2\/pages\/168\/revisions\/170"}],"up":[{"embeddable":true,"href":"https:\/\/web.csh.org.tw\/web\/224020\/index.php?rest_route=\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/web.csh.org.tw\/web\/224020\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=168"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}