肝癌發生自發性肝癌破裂病人接受居家安寧照護之經驗分享：2例報告

HOME HOSPICE CARE FOR PATIENTS WITH SPONTANEOUS RUPTURE OF A HEPATOCELLULAR CARCINOMA: TWO CASE REPORTS

高以信(Yee-Hsin Kao) ； 柯美伶(Mei-Ling Ko) ； 蘇盈惠(Ying-Hui Su) ； 魏美琴(Mei-Chin Wei)

《秀傳醫學雜誌》 20卷1期 (2021/06) Pp. 38-44

https://doi.org/10.3966/156104972021062001006

摘要

肝癌末期病人是安寧居家收案常見的對象之一。自發性肝癌破裂在肝癌病人的發生率約為3－15％，但是卻有極高的死亡率。本文分享肝癌末期病人在接受居家安寧後，發生自發性肝癌破裂，經與病人及家屬討論後，病人與家屬決定在家接受安寧照護，之後在家中安祥往生的個案。另一案例為發生自發性肝癌破裂後，病人呈現休克，立即被送至急診處置，住院後第二天，因病況惡化，家屬希望在宅善終，病人出院後在家往生。本文建議肝癌末期病人接受居家安寧照護時，在與病人及家屬作病情解釋與預後告知時，應提及自發性肝癌破裂的可能性與預後，並討論假設發生自發性肝癌破裂時以醫病共享決策模式作出最適宜之處置決策。

關鍵字

肝癌 ； 自發性破裂 ； 居家安寧療護

並列摘要

Patients with advanced hepatocellular carcinoma are given home hospice care. Spontaneous rupture of a hepatocellular carcinoma is a rare complication for patients with hepatocellular carcinoma (3-15%), but it is the third highest cause of death for hepatocellular carcinoma. This study concerns two patients with spontaneous rupture of a hepatocellular carcinoma who received home hospice care. One patient received conservational treatment and palliative care at home during spontaneous rupture of a hepatocellular carcinoma and the other received incomplete transcatheter arterial embolization in hospital after a sudden spontaneous rupture of a hepatocellular carcinoma. The results of this study show that physicians must tell patients and families about the complications and prognosis of a spontaneous rupture of a hepatocellular carcinoma using a model of shared decision making and consider the patient's decision when the condition occurs.

並列關鍵字

Hepatocellular carcinoma ； Spontaneous rupture ； Home hospice care