è???????????è?????????¤??§????????????????????????????è???????????????°??????????????????????????????????é??è?????????±????é?????è?????????????????????????????????????¨è??????????????????????????????????§???????????¨??¨???è???????????????????°????????????????????°???
MDTè??????¨????????????§è????¤????????????è??????????¨?????§???é??é??????????°é??è§??????¨????????§è???????¨??¤è?????????????????????????????è????????????§???????????????¨???è?????é???????????????????????????????????????????????è??????¤?????§?????????????????????±è?????2025??????????????????è???????????é????????è?????MDT????°???????????????·????????????è?????è????????????????????è·????
??°?????±è????????è??????¤?????§???????????????°è???±????é?????è??è?°????????????è???????????è??è??MDT?????????????????????è????????MDT?????????????¤§?????±???????????°???????????±è??è????????
?????????????????????è????????????§???????. ??????è??????¤?????§?????????????????????±è??(2025??????)[J/CD]. è????¤????????????????????????, 2025, 11(3):28-37???
??°???????????±è????????è?????MDT?¨????????????????????????¨è???????????
1. ???????§???¤??????????????????è??è????????
è??????¤?????§?è????????é????????è?????????????????é????????è??è???¤??§?????????¨????§??¤??§??????????????§????è????¤????§???????????§??????±???è??????§???????????§??????????????????????????????????è?????????§?????????????????§?????§???¤??????è???????????é??è?·???????§???????????§??????????????§????è???¤??§??????????????§????é??é?????è??????????¤??????????????????
MDT?????·???è??è????????????????????é?????è??è???????????????????????????????????è§????è??è???¨???????????????????????§??¤?????§??¨?????????????è?????????????????????????????????§???¤/????????????è????????è????±???????§???¤/??????????????????è??è???¤??§?/è???????????????????????????§???¤??????è????????/????????????????????????????¤?????§????????¨?????????±???é?¨???MDTé???????????è??è?????é??????±?MDTè?¨è??????????????????????¨????????¨é?¨???è?????è????????/???é??è???????????è??è??MDTè?¨è?????????????????????????????è????????è??è????????????§???¤è??è???????????
2. ???è???????????è±?
????????????????????????MDT?????????è±????????????????è????????è????????è????????è????????è??????¤???????é???????????è???????????è??????????????é??????????????????????????è????????è????????è?¨è??è§?è??/????????¨è?????é??é??????????????????????????é???????§è??è????????????????????????????????é???¤?????§?è???????????è??????????¨???è????????????????????é???????§è????°è???????????????????§????????????è?????????????????è?¤???é??è??è?¨è????????è?????
3. è?????MDT?????????
è?????MDT??¨???????????????????????????é????????????????????
1????????????????????????
2????±?é?¨????????????????????????é???????????
3??????è?????????????????
4???é?????è§?è????????????????????????????????
5??????é????????????????????è?¨é???????????
6??????è????????????????????
??¨????????§è?????è??????????????2024?????°???????????? ???CNLC??????è??è?????è????????é??è?°?????????CNLC ???a??????b??????a??????b??????a??????b????????????è§??????????
?????????è??????????????????????????è·??????????
CNCL????????????????????????????????·??????????????°???????????????è·????é???????????è??è????????è????????????????????è??è????¤????????§??????è?????è?????????????????????¤?????·???????é??????????????????????????CNLC????????????è??????????¨???????????????é?????????????????é?????????±???°???è?????MDT??????????¤???·??§???????????§???
????????????2024 CSCO????????§è?????è????????????????????è????????è??????????????MDT???????????°???????????????????????????è§??????????
???è?????è??????????????????????????è·?????????¨???CNLC?????????è??????????????ALPPS???è?????è??è?????é?????é?¨é??è?????????????????è?????é?¤??????PVE???é?¨é??è??????????????MVI??????è??????????????
??????CNLC?????????è????±è?????è§?è??????????????è?????MDT?????????????????????????§?????????????
??°???????????±è????????CNCL Ia???è????????è???????¨è???????????
1. CNLC ???a????????????
???????????¨?????????PS???è?????0???2??????è?????è?????Child-Pugh A/B??§?????????è????¤???è????¤????¤§?????¤5cm????????±??????è??????????????è???¤?è???§????
2. è§?è??????????¨è??
?????????é?¤??????è???????????è???§??¤????
3. MDT??±è????¨è??
??±è??1??????????????????è?????CNLC Ia??????è?????é??é???????????é?¤???????¤???¨???è????????è????¤????¤§??????3cm?????¨è?????é??é????????????????¨è?????è§?è??????????????
??±è??2???è??CNLC??Ia??????è?????é??????????????é?¤????????????è??????????????è??è?????è????????????????????????¤?????°?è????????è????¤????¤§?????¤2cm?????????è???§??¤??????????????????????????????????é????????è???????????è??è????¤????¤§??????3cm???è?????è??????????????è????????è????????????????¨è????????????????????TACE?????????????????????è?????????????????è??è???????????????°??????????è????????è????????è?????????????¨????????????????????????MDTè?¨è????????è??è????????è?????????????????????????????
??±è??3??????????????????é?¤?????????è????????é????????????????????CNLC Ia???è????????è????????è??è???§??¤????
??±è??4????????????è??????????¨???CNLC Ia???è????????è????????è??è???????????é?¤???è???§??¤????????????????????°??????????SBRT??????????????§è??????????????è??è?????????????????
??°???????????±è????????CNCL Ib???è????????è???????¨è???????????
1. CNLC ???b????????????
PSè?????0???2??????è?????è?????Child-Pugh A/B??§?????????è????¤???????¤§??????5cm??????2???3???è????¤???????¤§?????¤3cm????????±?????????è§?è??????????????è???¤?è???§????
2. è§?è??????????¨è??
?????????é?¤???TACE??????è????????è?????TACE??????è???§??¤????
3. MDT??±è????¨è??
??±è??1???è?????è??Child-Pugh A??§?????????è?????15 min????????????30%???CNLC Ib???è????????è??é??é???????????é?¤????????????????????????é??é???????????é?¤????????????è????¤????????????è?????????????¨??????é?????????????????è??è??????§??????????è??è??????§????30%????????????è???????????è????????????¤??????§è????¤???40%???è???????????è????????è????¤??°??????3??????????±?é?????è??è????????????????????
??±è??2?????????????§???????é?¤è???????·???é????±?¤????é??é????????è??[????¤????è????¤???????¤§??????5cm?????????è????????è??è????????AFP????°????è??é??????????????è?????HBV DNAé??è??é?????]?????¨???è???????????????????????è??è??MDTè?¨è???????????????????????è????????????????°è?????????????????????????????
??±è??3?????????????????????é????±?¤????????????????è???????????????¤?????????????è??1???2???è???????§TACE???è????¨è???????¨?????????HAIC?????????????????????è?????????????????????????????
??±è??4?????????????§?è????°??????????????????é?¤????????¨??????é?¤???CNLC Ib??????è?????è?????????????§é??????????????è?????FLRè??????????¨è??è??è?????è??è?????é?????é?¨é??è?????????????????è?????é?¤??????ALPPS????????????è??TACE???HAIC???é?¨é??è???????????è?????????????????é???????§è????°???è??????????·?¤??????????é?¤?????????é???????????????????????é?¤???????????????????????????è????§????????¨??§??????
??±è??5?????????????§?è????°??????????????????é?¤???????????¨?????????é?¤??????è?????é??????????????é?¤???CNLC Ib???è????????è????????MDT???è????????é????¨TACE/HAIC????????????è????????è????????è???????????????????????é????°è??è???????????é?¤???è??è????¤????±?é????¨?????§???è??????????????è?????????????????é?¤?????????????±?é?¨???è???????????
??±è??6????????????é??????????????é?¤???2???3???è????¤???????¤§?????¤3cm???CNLC Ib???è????????è?????è?????è????????????????????è???????????è??è??è????????????????????TACE????????????
??±è??7???è???§??¤?é????¨???2???3???è????¤???????¤§?????¤3cm???è?????è??Child-Pugh B??§???CNLC Ib???è????????è???????????????????????????????????????????§?????????
??°???????????±è????????CNCL IIa???è????????è???????¨è???????????
1. CNLC ???a????????????
PSè?????0???2??????è?????è?????Child-Pugh A/B??§???2???3???è????¤???????¤§??????3cm????????±?????????è§?è??????????????è???¤?è???§????
2. è§?è??????????¨è??
?????????é?¤???TACE????????????é?¤??????è??/TACE??????è?????è???§??¤????
3. MDT??±è????¨è??
??±è??1??????????????????è???????????é?¤???CNLC ???a???è????????è????????è??è???????????é?¤?????????é??é???????????è??è????¤????±?é????¨?????§???è??????????????è?????????????????é?¤?????????????±?é?¨???è???????????
??±è??2?????????????§???????é?¤è??????????????é????±?¤????é??é????????è?????????¤????è????¤???????¤§??????5cm?????????AFP?°????è??é??????????????è?????HBV DNAé??è??é?????????????¨???è???????????????????????è??è??MDTè?¨è????????????????????è??è????°è?????????????????HAIC?????????????????????????????°è????????????????????????????????é????????????¤????è???§?é??é?????
??±è??3?????????????????????é????±?¤????????????????è????????è????¤?????????5cm???/????????????è???????????è???????????????¤???????è????????è??1???2???è???????§TACE???HAIC??????????????????è?????????????????????????????
??±è??4?????????????§????????????????é?¤???????????¨??????é?¤???CNLC ???a???è????????è?????é????????è?????????????§é??????????????è?????FLRè????????è????¤???è???????????è?????é?????è????????????????????é???????§è????°???è??????????·?¤??????????é?¤?????????é???????????????????????é?¤???????????????????????????è????§????????¨??§???
??±è??5????????????è????¤?·¨?¤§?????????è??è??????§?è???°?è???????????é?¤???CNLC ???a??????è???????¨è??è??ALPPS?????????è??TACE???HAIC???é?¨é??è????????????????????????????????è???????????è?????????????????
??±è??6?????????????§????????????????é?¤???????????¨?????????é?¤?????????é??????????????é?¤???CNLC ???a???è????????è?????è??TACE???????????????è????¤????¤§?????¤7cm??????è????????è??????????????TACE/HAICè?????????????????????????????
??±è??7???????????????é??????????????é?¤?????????TACE???è????????è???????????????????????CNLC ???a???è????????è??????°¤??????è?????è?????Child-Pugh B??§è????????é?????è???§??¤????
??°???????????±è????????CNCL IIb???è????????è???????¨è???????????
1. CNLC ???b????????????
PSè?????0???2??????è?????è??Child-Pugh A/B??§???è????¤??°??????4?????????è??????¤§???????????±?????????è§?è??????????????è???¤?è???§????
2. è§?è??????????¨è??
TACE????????????é?¤????????????è????¤?????????
3. MDT??±è????¨è??
??±è??1???TACE??????è?¤??????????????????é?¤????????????è?????????????¨??????????????????è????????????????°?????????TACE???HAIC???????????????è§????è§??????????????????????è??è?·???è??é??????????????é?¤è??????????????è??è??é?????????????????è????¤?????°??????????????????è????????????????????é????????è??????????¨TACE???HAIC????????????????????????
??±è??2???TACE/HAIC??????????????±??????è????°?????¨???è??MDTè?¨è????????????????????è??????????????é?¤????±?é?¨???è??????????????
??±è??3???????§????????????????é?¤???CNLC ???b???è????????è???????¨?????????????????????MDTè?¨è??????????????è?????è??TACE/HAIC???è?????é???????????è??????????????????????°è?????/è?????????????????è??è???????????é?¤??????è????¤????±?é????¨?????§???è??????????????è?????????????????è?????????°?é?????è??????¤???????é?¤è??????¤?????????????
??±è??4???????§???????è???????????é?¤???????????¨??????é?¤???CNLC ???b???è????????è????????è??????§????è??????????????è??????????????è??é????¨TACE/HAIC??????è?????é????????????????????è????°è???????????????§????????±??????????é?¤?????????
??±è??5????????????é?¤???è??????????????CNLC ???b???è????????è??è?????é?¤???????????¨??????é????±?¤???????????????????????¤???????è??1???2???è???????§TACE/HAIC??????????????????è??è??è???????§????????????/é?????????????????è?????????????????????????????è?????????????????????????????
??±è??6???TACE/HAIC??????????????????è??è?????TACE/HAIC????????????è???????????è??é?????????????????????????????è??TACE/HAIC??????TACE/HAIC???è?????é??????????????
??±è??7???????????§è???????????é?????TACE?????????????????????è??????????????????????????è??????????????????????????è????¨è???????????????????????????????¨??§???????????§??????è?????é??????????????????????????
??°???????????±è????????CNCL IIIa???è????????è???????¨è???????????
1. CNLC ???a????????????
PSè?????0???2??????è?????è??Child-Pugh A/B??§??????è??????¤§??????è????¤??°???????????±??????è???????????è?????è???¤?è???§????
2. è§?è??????????¨è??
TACE???è????????????????????????????????????????????é?¤????????????
3. è???????????é?¨é??è???????????PVTT????????????
PVTT???????????????????????¨è??é????¨?¨??°???????????????????PVTT??????é?¨é??è??è???????????????????????????????????è????????è????????é?¨é??è????????????????????????????????è??é?¨é??è???·?????????????????????????????????????è??é?¨é??è????????????????????????????????è??è?????è?????é??è?????
??????é??è??????????????é?????????????????è?????è???????????é?¨è???????????PVTT????????????é???????????
4. MDT??±è????¨è??
??±è??1????????????????¤?????????????/???è??è??è?????é?¤??????PVTT I/II??????è?????è??TACE/HAIC?????????è??è??é?¨?????§?????????è????????PVTT ???/?????????è????????é?????TACE/HAIC?????????
??±è??2???????§????????????????é?¤???CNLC ???a???è????????è????????è?????è?????????????????TACE/HAIC??????/???è?????????????????????????°è?????????????????è??è???????????é?¤???
??±è??3???????§???????è???????????é?¤???????????¨??????é?¤???CNLC ???a???è????????è????????è??????§????è??è??è??????????????è??????????????è??é????¨???????????????TACE/HAIC???è???????????????????????è???????????????????????é??è????¤è??è?·???è??????·¨?¤§è??????????????é?¨é??è?????????????????è??HAIC?????????è?????é??????????????/??????????????????é??è?????????????????è????°è???????????????§????????±??????????é?¤?????????
??±è??4???????§???????????????????é?¤???????????¨?????????é?¤???????????????é??????????????é?¤???CNLC ???a???è????????è???????¨è??é?????????????????????????????????±?é?¨??????????????????????????????????????????è??è§?3.6.3????????????CNLC ???a???è????????è????¨?¨?????????????????????????è????????????????¨?¨?????????????????±?é?¨???????????????è?????é?¤??????TACE/HAIC??????????????????è????¨?????????????????????TACE/HAIC????????????????????????è????¨???????????????é?¤??????????????????????????????
??±è??5????????????é?¤???è?????????????¨è??è??1???2???è???????§TACE/HAIC??????????????????è?????????????????????????????
??±è??6???é?????é?¨é??è????????????????????????????????????¤?é????¨?¤??????????é?¨???é?¨é??è?????é????????????¤????????????????
??°???????????±è????????CNCL IIIb???è????????è???????¨è???????????
1. CNLC ???b????????????
PSè?????0???2??????è?????è??Child-Pugh A/B??§??????è??????¤§??????è????¤??°?????????è??????????±??????è????????????????????è???¤?è???§????
2. è§?è??????????¨è??
???????????????TACE????????????
3. MDT??±è????¨è??
??±è??1?????????è?????è??Child-Pugh A??§???è???????¤7??????B??§???è???????????????????¨è?????é?????????????????è?????è????????????????????è???????????è?????è???????????????±??????????é?????????°?è???????????????????????????¤????é???°??????????????°???????é?·?????????????????????é???°?????????????é????????????????????????????????????°¤??????è????????è????¨?????????STRIDE?????????????????????????????¨???è???????????????°?è???????????????????????/???é?·????????????????????????????????¨è????????é???°?????????????????????????????????????????°¤?????????????????????????????????é?·??????????????????????????????????????????é?????????°????é?·è??è???°¤??????????????????è?????è??Child-Pughè????????7??????B??§???è???????¨è????????????????????????§????????????????é???????§?????¨??·???è?????é?????è???????°??????è????????é???????????????·????è????????è??è???????????????????????è?¨è??è????????
??±è??2??????b??????è??????????????é??è??è????????????????¨?¨??????????è????°è????¤??§???????????????????¤????è??????????????è????????????????°??????è???±?????????????????????????è????¤è???????????è??????±?é?¨???????¤??????°????????????
??±è??3???è????¤è??è?·???è???????????????????????è?????????????????è???¤?????????§???è???????????è?????é?????è??????±?é?¨????????????????????????é?¤????±?é?¨???è?????TACE/HAIC?????????????????????????°?è????¤è??è?·?????????è????¤è???±???????è§?????????????é?????è??????????????
??±è??4?????????è???????????é?¨è???§????è??è???§?????·??·????è???§????è?????è??è???§????è?????è???§????è??è?????è??è??è???§???????è??????????¨????????????????????????è??????¤?????????????????¤?????????????
??±è??5?????????è?????è??Child-Pughè????????7??????B??§???è????????è????¨è????¤?????????????°?è???°?è?????è??????¤?è??Child-Pugh B7??§?????????è????????????????????
??°???????????±è????????CNCL IV???è????????è???????¨è???????????
1. CNLC IV????????????
PSè?????3???4?????????è?????è??Child-Pugh C??§??????è??????¤§??????è????¤??°?????????è??????????±??????è?????????????????è????????è???¤?è???§????
2. è§?è??????????¨è??
?????????????????????è???§??¤????è??????????¤???
3. MDT??±è????¨è??
??±è??1??????è??????????????????????????è?????????§??????????????§?????????????????§???¤?????????MDTè?¨è????????è?????????????¤è????????????????????????????¨??¤è??è????????????????????é??é?????????°§?????????è?????è§???????è?????è??è??????¤??????¤?????¨???è?????????§?????????????è?????è???????????????????¨????°???????????¤???¨?°?è?????????????????è?????è???????????HBV?????????????????????è??é??é????????è???????¨è???????????è?·???é??????±?????????????????????????
??±è??2???????????????????????????è?????????§??????????????§???????????§???????????§????è??????§?????§???¤??????MDTè?¨è????????è????????????????????????????????è§???????????????????????????????????¤????è???°????è???????????????????????è??????????????????????????è???????????????????????è§????è?????????????????????§????é???????????????????????????°????è???????????è????????è?????
??±è??3???????????????????·??¤§?????§é???±±?????????????????????????¤§?????¤6.5cm???è????¤??°?????¤3????????????????¤§?????¤4.5cm??????????¤§???????????¤8.0cm???????¤§è???????????è????????CNLC ??????è?????????????¨è??è??è??è???§??¤???????
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