确诊复发转移要转院的原因

确诊复发转移的患者要转院到省肿瘤医院治疗,确诊肝肺多发转移或原位复发患者要到全国十大肿瘤医院诊疗的原因

第一节  确诊晚期患者要去全国十大肿瘤医院诊疗的原因,不专业医院对肝肺转移确诊手段和时间,往往耽误了患者肝肺单发转移可以手术切除的黄金机会

6年的癌群解答经历,我看过太多太多不专业的医院医生,在患者肝肺有高度怀疑转移结节,复查时都已经发展到增大、密度增高,甚至不均匀强化了,甚至还多发很多小于5mm的类似实性结节了;患者或家属最信任的手术医生看完复查报告之后,都还是无法判断这类高度怀疑的结节是不是肝肺的转移癌,而医嘱患者或家属再随诊3-6个月继续观察,而随诊3个月复查报告出来之后,大概率的结果就是肝或肺原来的高密度实性结节,或者轻度强化结节,已经变成了多发高密度环形强化结节,最大者也超过10mm,甚至20-30mm了;这时候医生才敦促患者和家属去做派特ct检查确诊已经为时已晚,医生告诉你确诊肝或(和)肺多发转移时,也同时会告诉你患者已经是肝或(和)肺多发转移,有的患者癌胚抗原也随着飙升,很遗憾的告诉你患者已经无法手术,这时,确诊肝肺转移的时间或许距离手术时间更长了,手术医生被质疑术前没有发现肝肺有高度转移结节而匆忙手术、或者手术切除得不太干净的压力或者更小了;但是患者同时也失去了3-6个月的确诊肝肺单发转移可以手术的黄金时间,而随诊3-6个月之后一确诊就是肝或(和)肺多发转移而没有手术机会了。

而通常这类不专业的医院面对这种多发转移的的患者绝大部分是转到肿瘤内科去做化疗,有些有介入科的医院医嘱患者去介入科做复发率非常高的消融治疗和第二次化疗加靶向药治疗,而面对这类失去宝贵的早期远端肝肺转移手术机会的患者,医院“治疗”肝或(和)肺多发转移患者的治疗方案,往往是姑息性手术、消融/化疗、换二线药化疗、加靶向药治疗3-6个月之后,患者大概率的身体在两三年接受2次化疗、低位直肠癌的放疗、1-2次手术之后,身体各项指标在复发转移后的第二次化疗的下半阶段,就因为肝肾功能不全甚至接近衰竭,血象严重不合格而停止治疗。

第二节  不专业医院对肝肺多发转移患者的治疗手段和技术有限,患者继续留在这种医院治疗的结局多数人财两空

非专业肿瘤医院,不单只不具备做复杂而专业性强的低位直肠癌手术,面对复发转移的患者治疗技术与手段也非常有限,通常只有放化疗条件,不具备多学科联合诊疗的医院,不具备早期确诊、早期切除肝肺转移病灶的能力,严重缺乏根治肝肺多发转移患者做根治手术的专家和治疗综合能力,一般治不好四期肠癌患者的病情,确诊原位复发或(和)肝肺转移患者或家属,要及时转院到省肿瘤医院甚至全国十大肿瘤医院诊疗,才可以得到更高的晚期治愈率,而患者和家属花在省肿瘤医院或全国十大肿瘤医院根治的钱,却远远少于你继续留在非专业医院做不科学的、非根治的、治疗过程痛苦的、相对来说属于过度治疗的、严重损害患者身体的治疗费用为低。

省肿瘤医院和全国十大肿瘤医院根治复发转移的手段主要还是靠手术,其次为比较成熟的介入消融放化疗治疗,对无法根治的患者及时转入舒缓治疗,做多学科会诊之后,根据患者的身体体质和病情做出最科学的诊断,用患者受益的综合治疗方法做舒缓治疗,让患者带癌生存,保证患者在进入晚期还能够过相对舒服的生活。

而不是像很多不专业医院的肿瘤内科医生一样,在患者复发转移之后,重新接受第二次化疗疗程做到第四次时,肝肺多发的转移的患者往往复查时影像检查还在进展,肿瘤标志物检查癌胚抗原还在继续升高时,不顾患者因为化疗遏制白细胞、红细胞、血小板等血象指标处于合格下限,生化指标显示肝肾功能是否正常的生化指标转氨酶等指标数值飙升,肝肾功能已经不能够有效处理化疗毒性的情况下,还在套用指南“四次奥沙利铂+卡倍他滨片化疗无效转二线药伊立替康治疗”的死教条;而无视患者剩下的理论上可以接受化疗极限的4次化疗疗程,根本就不可能消灭患者的肝或(和)肺多发转移的病情的循证科学现实,还是换副作用反应巨大的伊立替康二线化疗方案继续做漫无目的的化疗,这种不专业的治疗手段往往成为摧垮患者脆弱不堪身体的元凶,通常绝大部分患者在接受两次伊立替康+卡倍他滨+靶向药化疗之后,肝肾功能急速恶化,肾功能衰竭到无法排尿而要做尿管造口手术,转氨酶指标全面飙升,而被医嘱转科治疗调理身体之后再做化疗治疗。

第三节  不专业医院对肝肺多发转移患者的治疗手段和技术有限,在晚晚期患者身体指标接近崩溃时还进行积极治疗的策略值得商榷

就在我写电子书的这段时间,就出现了两个这类的过度化疗病例,可见这类案例发生概率不在少数,其中第二个案例的家属看过群文件有关“晚晚期患者必读章节”知道全身多处转移和肝肺多发转移、患者血象恶化,肝肾功能恶化的晚晚期患者谨慎继续积极治疗策略,慎用副作用很大、患者身体反应强烈的二线化疗药伊立替康化疗之后,跟化疗医生商量是否必须使用伊立替康化疗的问题,而医生却坚持要试试2次伊立替康化疗,结果第二次伊立替康化疗之后,患者肝肾功能彻底崩溃,肾功能衰竭到尿不出来,肾功能指标接近尿毒症的水平,要做尿道造口手术,患者身体身体彻底垮掉时,紧急来群里要求做病情分析和治疗策略指导。

我详细的看完患者的所有群友提供的患者检查报告之后,告诉这个群友现在唯一积极治疗的策略是去肿瘤医院的中医部看中医,和看泌尿内科、肝胆内科,治疗调理患者的肝肾功能和血象,及时调整患者的治疗目标,及时把治疗目标调整为调理患者的身体平衡,调理到患者能吃能喝、能睡能走、能拉能尿、身体没有疼痛,没有明显的后遗症、生活基本能够自理;和医生商量用副作用最小的卡倍他滨片或靶向药做舒缓治疗,在患者身体可以耐受的前提下尽力温和控制病情的进展,把维持晚晚期患者的生活质量、延缓病情进展取得科学的平衡,才是肠癌晚晚期患者舒缓治疗的最高医术精髓,而不是盲目的加重药量做无谓的自杀式“万岁冲锋”,不要被道德绑架而做出不科学的积极治疗决策。

第四节  最近一个下午两个怀疑肺转的群友问询,我研究完所有报告之后的解答和建议和一个肝肾功能处于崩溃边缘的患者使用伊立替康二线药化疗结果的判断问答原文照登
 

【群主】15-港-患-我 2021/7/12 18:15:48

    @20-苏-属—敏  看完你家的术后病理,就基本能够梳理出来几个理论上和经验上,大概率是肺转的根据了,你看看群文件里我写的不专业的医院医生少切点,术后病理分期分轻点,化疗方案做轻点,就是导致患者在术后两年内肝肺转移的罪魁祸首,你家的诊疗经历基本符合我以往的经验套路,你家在地级市人民医院的附属医院手术,人民医院我平时说得多了,你家还是它的附属医院做的手术,而术后病理,肠壁已经浸润至浆膜下层了,而术前核磁是表述肠腔狭窄,病变累及浆膜,周围脂肪间隙模糊,这种术前的描述,群文件是建议要去省肿瘤医院治疗和做足化疗的病情,而术后病理描述,虽然没有突破肠腔,也没有淋巴结转移,这种病情在肿瘤医院内科医生是要做奥沙利铂加卡倍他滨片化疗6-8次的,而你家竟然做4次希罗达化疗就拉倒了?!!!我梳理出来几个经验证据做的综合判断是那个长大的肺结节是高概率肺转了。建议是不要再随诊三个月,立即去省肿瘤医院找专家医生寻求尽快确诊,尽快采取治疗措施,不要浪费时间,三个月之后可能就是10mm或者多发转移了!!!我情愿三个月后复查结果我被打脸,你家排除肺转了!

【群主】15-港-患-我 2021/7/12 18:46:44


   看完你家的所有术前术后的报告,你家犯的忌讳,跟敏她家差不多,你家虽然写着没有淋巴结转移,但是,那些淋巴结是在肠周捡的,不是医生按照指南规范位置切除的,你家比她家好一点就是多做了4期的口服卡倍他滨片化疗,而你家跟她家一样都是侵犯浆膜下层了,而术前ct报告更加是一般t4的描述“管腔变窄,周围脂肪间间隙模糊,术后病理还有“肿瘤最外缘紧贴直肠筋膜系膜”的描述,你要是术后加群,发术后病理,见到只是口服方案,我是肯定会苦口婆心让你去省肿瘤医院再做一次化疗方案,再回老家化疗的;不专业的医院医生少切点,术后病理分期分轻点,化疗方案做轻点,止吐止泻不做或少做点,患者上吐下泻血指标下降不合格而完成不了疗程;始终还是这几年导致患者在术后两年内肝肺转移的罪魁祸首!!很不幸,你家的结论跟敏她家一样,大概率是肺转了,结论一样,建议也一样。

【群主】15-港-患-我 2021/7/12 19:42:23
16-吉-属-心态 @15-港-患-我 现在肺部进展,会觉得气短,偶尔咳嗽,肺部的控制不好,现在二线化疗方案效果也不好,不知道肺部的能放疗吗?

@16-吉-属-心态  复发之后做过什么化疗了?血常规和生化报告能不能发我看看,现在做二线化疗风险巨大,而且患者根本就不受益,慎重做二线方案,特别是那些看指南不看患者身体的肿瘤内科医生,粗暴的一线化疗还进展就换伊立替康化疗,结果成为催垮患者身体的罪魁祸首,而进展一点都控制不了,现在你家的目标在问完医生的肯定不能够靠化疗根治的肯定意见之后,根据患者的身体状况,患者的意愿,家庭的经济和成员的意愿,及时调整治疗目标,让患者能吃能喝,能拉能尿,能睡能起,没有明显病痛,没有治疗后遗症,能够自理,带癌生存是最高的目标,目标高了,积极治疗患者身体很快就垮掉了,积极治疗只会导致患者早走!群入群必读文件晚晚期患者细看章节,你自己去看看,这些共性的话不是今天临时对你家说的,而是几年前的群文件就告诉所有群友的!慎重选择积极治疗!切切!

【冒泡】16-吉-属-心态 2021/7/12 19:46:12
@15-港-患-我 第一次用伊立替康就导致无法排尿,急性肾衰竭,肌酐高达800多,最开始说用二线伊立替康的时候,我们就特别反对,医生说用两次评估下看看,第一次之后就膀胱造瘘了


16-吉-属-心态 @15-港-患-我 第一次用伊立替康就导致无法排尿,急性肾衰竭,肌酐高达800多,最开始说用二线伊立替康的时候,我们就特别反对,医生说用两次评估下看看,第一次之后就膀胱造瘘了

【群主】15-港-患-我@16-吉-属-心态  2021/7/12 19:55:53

嗯嗯,证明我的判断是对的。复发化疗换二线药,经验上是催垮患者身体的一剂毒药,这种病情那是做几次化疗可以根治的,而二线药一上,肝肾功能和血指标,并发症就什么都来了。。

【群主】15-港-患-我 2021/7/12 19:55:53
16-吉-属-心态 @15-港-患-我 我觉得您说的很对,现在他这种情况不可能治愈,不能因为进展就盲目换药

@16-吉-属-心态 换二线药就等于治疗式的自杀行为,不要被道德绑架,及时调理治疗策略,现在在省肿瘤医院中医部看中医,调理患者身体的后遗症,调理身体平衡,达到我上面说的目标,是患者唯一受益的积极治疗措施!

【群主】15-港-患-我 2021/7/12 19:58:55
这种病情!!!哪是换二线化疗药可以治愈的啊!!肝肾功能和血象去到临界点就要果断调整治疗目标和治疗方式,那能够让那些误解指南胡闹的肿瘤内科医生胡来呢?!!!

【活跃】19-南昌-家属-天意 2021/7/12 20:00:49
晚期患者 尤其是年龄较大身体基础不好的患者 我认为生活质量比生存期更重要

【冒泡】16-吉-属-心态 2021/7/12 20:00:53
@15-港-患-我 奥沙做了10次,

【群主】15-港-患-我 2021/7/12 20:02:13
我可以写成入群必读文件的病例,都是这5-6年屡见不鲜绝大概率发生的,具有共性的严重问题,我才会写进这么重要的文件,它可能是超过2000人都有可能看见的文件啊!我一个不谨慎就会挨骂!

【冒泡】16-吉-属-心态 2021/7/12 20:02:18
@15-港-患-我 你说的太对了,没用二线人还行生活质量还可以。

【冒泡】16-吉-属-心态 2021/7/12 20:04:02
@15-港-患-我 看入群比读关于晚期患者不要过度治疗的内容,所以一开始就不同意换二线,医生非说二线效果能好,用2次就评估下

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