最近在 Anti-Cancer 板看到一篇文章，
http://esther7349.blogspot.tw/
病人家屬提到病人在台大因為肝腫瘤及黃疸
過高，被建議接受安寧醫療，可是後來不放棄，
到了榮總接受換肝成功。
　想問的是我們去看安寧照會的時候，腫瘤、
內外科醫師說沒辦法醫治了，我們也就相信他們
的說法，把病人接收來安寧病房、共照或門診。
可是像 anti-cancer版發生這種情形，是不是每次
外科醫師發的安寧照會，都要了解一下病人是不是
也被其它醫院醫師認定無法醫治了呢？…謝謝


（病人的資料，如果侵犯了隱私或不妥，請告知我將它刪除）
Diagnosis
1.Hepatocellular carcinoma, T3bN0Mo, stage IIIb,
status post S5 hepatectomy(2011), recurrenc with bile duct
obstruction due to tumor thrombus in BD
2.HBV related cirrhosis

2011, pathology:
Liver, segment 5, segmentectomy, hepatocellular carcinoma, grade 2
Blood vessel, vein, portal, hepatocellular carcinoma, metastatic

Lab
2012/6/5: Hb 12.6, Plt 192k, WBC 8.38k, Cre 0.67,
T-bil/D 29.55/21.6, AST 309, ALT 347, ALP 366, INR 1.13

6/18: T-bil/D 18.7/14.23
7/2: Hb 8.3, WBC 15.51, plt 292k, Cre 0.6
T-bil/D 22.61/17.05, AST 344, ALT 227, INR 1.47
7/9: Hb 8.2, WBC 17.68k, plt 109k, T-bil 17.85,
ALT 137, INR 1.51

CT With/Without Contrast-Abdomen 影像時間: 2012/07/08 06:41
報告內容:
CT of abdomen and pelvis without and with contrast enhancement
shows: 1. Liver cirrhosis with uneven hepatic surface. Ascites.
2. Post-operative changes at S5. 3. An infiltrative mass at the
hepatic hilum, with bile duct and left portal vein invasion,
causing dilated bilateral IHDs. 4. A hepatic artery pseudoaneurysm
(1.8cm) at S3, with prominent hemobilia, more in the left lobe.
5. Right renal stones. 6. No definite lesion of the spleen,
pancreas, left kidney, and both adrenals. 7. No abdominal or pelvic
lymphadenopathy. 8. Atelectasis of bilateral basal lungs, with right
pleural effusion.
Impression: Liver cirrhosis. Recurrent tumor with bile duct invasion.
Hepatic artery pseudoaneurysm with hemobilia.


2012/6/5, Abdomen CT
Liver: Postoperative change at S5. Nodular liver contour. -
Portal venous system: Patent. - Spleen: Normal. -
Pancreas: Normal. - Adrenal glands: Normal. -
Gallbladder and biliary system: S/P cholecystectomy.
A 4x2.5x2.5cm soft tissue mass is noted at the hepatoduodenal
ligament with suspicious distal IHDs and CHD invasion,
causing IHD dilatation at right anterior lobe and left lobe liver.
- GI tract: No evidence of bowel obstruction. - Urinary system:
No evidence of obstructive uropathy. Several tiny right renal stones. -
Peritoneum/retroperitoneum: A 4x2.5x2.5cm soft tissue mass is noted
at the hepatoduodenal ligament with suspicious distal IHDs and CHD
invasion. Multiple small para-aortic lymph nodes.
Impression: 1. Liver cirrhosis. S/P OP. 2. Hepatoduodenal
mass with suspicious distal IHDs and CHD invasion,
causing IHD dilatation at right anterior lobe and left lobe liver.

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