57歲的李先生為B型肝炎帶原者，平時並沒有定期接受追蹤檢查，結果在一次健康檢查中赫然發現肝臟中央有顆11公分的肝癌，同時也已轉移到肝臟左葉，經影像及血管檢查確診為肝癌中期。依照以往臨床案例統計，肝癌中期的平均存活期為10多個月，5年存活率僅約2成。成大醫院移植外科主任林毅志醫師指出，考量腫瘤分布與肝功能情形，已排除手術切除之可能性，在建議下，病人最後接受經肝動脈化學栓塞術，並成功縮小腫瘤，達到可進行肝臟移植的標準，而即將步入婚姻的兒子也願意捐贈肝臟，為父親的生命與健康盡一份心力。肝臟移植手術十分成功，李先生與家人也因此能續享天倫之樂。
肝癌長期占據國人主要死因之一，最主要原因是肝癌好發於已有病理變化之肝臟身上，其中，慢性肝炎及肝硬化病患者是發生肝癌的危險族群。
林毅志醫師表示，肝臟已有病理變化的病人，醫師必須同時考量腫瘤、肝機能及病患整體健康狀態，能接受積極手術切除的並不多，再加上病人接受治療後，已有慢性肝炎或肝硬化之剩餘肝臟仍是發生肝癌的危險環境。所以，治療肝癌的策略雖然很多，但是復發機率仍然很高，手術切除後的病人5年復發率高達5-7成，更遑論接受其他治療成效較差的病患。
因此，肝臟已有病理變化的肝癌病人，以肝臟移植作為治療策略之一。近年來，移植醫學已累積很多經驗，已確立可移植的肝癌患者之腫瘤期別標準，成效也經實證醫學證實。
至於李先生的案例，雖然剛診斷時的期別已超出標準，但經過栓塞等降階治療可以達到標準，其接受肝移植的存活率與原來就符合換肝標準不必降階治療的病人相當，5年復發率可以降到約1成。
因此，林毅志醫師也特別指出，積極治療是保命的重要關鍵，每位病人的病況不同，並非治療後都能成功降期，但及早發現即時治療，就有望延長生命。他也呼籲，治療切勿拖延，必須把握黃金時機，才能爭取生機。
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Mr. Li, 57, is the original hepatitis B patient. He does not regularly follow up the test. In a health check, he found a liver of 11 cm in the center of the liver. He also transferred to the left lobe of the liver. The vascular examination was diagnosed as mid-stage of liver cancer. According to previous clinical case statistics, the average survival time of liver cancer in the middle period is more than 10 months, and the 5-year survival rate is only about 20%. Dr. Lin Yizhi, director of transplant surgery at Chengda Hospital, pointed out that considering the tumor distribution and liver function, the possibility of surgical resection has been ruled out. Under the suggestion, the patient finally undergoes transcatheter arterial chemoembolization and successfully reduces the tumor to achieve liver function. The standard of transplantation, and the son who is about to enter the marriage is willing to donate the liver to do his part for his father's life and health. The liver transplant operation has been very successful, and Mr. Li and his family can continue to enjoy the family.
Liver cancer has long occupied one of the main causes of death in Chinese people. The main reason is that liver cancer occurs in the liver with pathological changes. Among them, patients with chronic hepatitis and cirrhosis are at risk of developing liver cancer.
Dr. Lin Yizhi said that patients with pathological changes in the liver must consider the tumor, liver function and overall health of the patient. There are not many active surgical resections. In addition, patients have chronic hepatitis after receiving treatment. Or the remaining liver of cirrhosis is still a dangerous environment for liver cancer. Therefore, although there are many strategies for treating liver cancer, the chance of recurrence is still high. The 5-year recurrence rate of patients after surgical resection is as high as 5-7%, let alone those patients with poor treatment results.
Therefore, liver cancer patients with liver pathological changes have adopted liver transplantation as one of the treatment strategies. In recent years, transplant medicine has accumulated a lot of experience, and has established a tumor stage standard for transplantable liver cancer patients, and the results have also been confirmed by empirical medicine.
As for Mr. Li's case, although the period at the time of diagnosis has exceeded the standard, the level of treatment after embolization can reach the standard, and the survival rate of the liver transplant is equivalent to that of the patient who does not need to reduce the level of treatment. The 5-year recurrence rate can be reduced to about 10%.
Therefore, Dr. Lin Yizhi also pointed out that active treatment is an important key to life-saving. Each patient's condition is different, and it is not a successful period after treatment. However, early detection of immediate treatment is expected to prolong life. He also appealed that treatment should not be delayed, and it is necessary to grasp the golden opportunity in order to strive for vitality.
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