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:病例報告

Home Hospice Care for Patients with Spontaneous Rupture of a Hepatocellular Carcinoma: Two Case Reports

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。

 

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 hepatocel- lular carcinoma who received home hospice care. One patient received conser-vational treatment and palliative care at home during spontaneous rupture of a hepatocellular carcinoma and the other received incomplete transcatheter arte-rial embolization in hospital after a sudden spontaneous rupture of a hepatocel- lular 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 hepatocellu- lar carcinoma using a model of shared decision making and consider the patient’s decision when the condition occurs.