李进教授直播回顾 | 结直肠癌病人的这些治疗能够暂停，认识一下
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/oZVJebibh9RmQGhKKzHVhe5FrPjR29zynez0LskaIwP9gYgEgiaWXF5bCc0d3EutcMGRDicItWeJMIVo9oic33u9cg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2月23日，亚洲肿瘤联盟主席、上海同济大学东方医院肿瘤医学部<span style="color: black;">专家</span>李进教授做客《人民名医》新冠肺炎防治<span style="color: black;">尤其</span>策划肿瘤系列直播间，为网友<span style="color: black;">伴侣</span>们<span style="color: black;">指点</span>疫情<span style="color: black;">时期</span><span style="color: black;">怎样</span>做好结直肠肿瘤的<span style="color: black;">疾患</span>管理。以下是问答精选内容。</span><img src="https://mmbiz.qpic.cn/mmbiz_jpg/oZVJebibh9Rne2jqrapnN8z0tFqubbKtR15n4aZjz2nqkqnlqhUVicYfTqa0J1AfRNibiawVEmTvAuI5zzpemibrdMQ/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><strong style="color: blue;">网友：</strong><strong style="color: blue;">结直肠癌<span style="color: black;">病人</span></strong><strong style="color: blue;">在疫情<span style="color: black;">时期</span><span style="color: black;">那些</span>治疗是能暂停的，<span style="color: black;">那些</span>是<span style="color: black;">不可</span>停的？</strong></span><span style="color: black;">李进教授：<span style="color: black;">针对</span>做辅助治疗的<span style="color: black;">病人</span>，<span style="color: black;">倘若</span>用的<span style="color: black;">方法</span>是奥沙利铂联合氟尿嘧啶或卡培他滨，<span style="color: black;">能够</span>把奥沙利铂停下来。辅助治疗单用卡培他滨或替吉奥<span style="color: black;">亦</span>是可取的，卡培他滨的证据比替吉奥<span style="color: black;">更加多</span>更好一点，<span style="color: black;">因此</span>我<span style="color: black;">意见</span>用口服卡培他滨来取代静脉的氟尿嘧啶。</span><span style="color: black;"><span style="color: black;">针对</span>复发转移<span style="color: black;">病人</span>做的姑息治疗，<span style="color: black;">倘若</span>是用奥沙利铂联合氟尿嘧啶或伊立替康联合氟尿嘧啶的治疗<span style="color: black;">方法</span>，<span style="color: black;">倘若</span>联合了靶向<span style="color: black;">药品</span>，<span style="color: black;">意见</span>继续用靶向<span style="color: black;">药品</span>，<span style="color: black;">而后</span>加上<span style="color: black;">基本</span>用药卡培他滨或氟尿嘧啶。<span style="color: black;">这般</span>做的好处是毒性比较低，在治疗过程中不<span style="color: black;">必须</span>频繁到医院去处理毒性反应，<span style="color: black;">因此</span>这两个药<span style="color: black;">意见</span>不要停。</span><span style="color: black;">奥沙利铂和伊立替康都<span style="color: black;">能够</span>暂停一下，但<span style="color: black;">倘若</span>您在的医院<span style="color: black;">能够</span>按原有<span style="color: black;">方法</span>继续治疗<span style="color: black;">亦</span>没问题，要适当<span style="color: black;">掌控</span>一下化疗的剂量，<span style="color: black;">由于</span><span style="color: black;">倘若</span>有了毒副反应，可能<span style="color: black;">大夫</span><span style="color: black;">无</span><span style="color: black;">那样</span>多的精力去处理。</span><span style="color: black;"><strong style="color: blue;">网友：</strong><strong style="color: blue;">结直肠癌化疗后腹胀、腹痛怎么办？</strong></span><span style="color: black;">李进教授：<span style="color: black;">一般</span>化疗<span style="color: black;">药品</span><span style="color: black;">导致</span>腹胀、腹痛的<span style="color: black;">状况</span>较少。除非是伊立替康，在用药后5天<span style="color: black;">上下</span><span style="color: black;">显现</span>腹泻的<span style="color: black;">出现</span>率比较高，<span style="color: black;">能够</span>用易蒙停，腹泻后第1次吃两粒，<span style="color: black;">而后</span>每两小时吃1粒。<span style="color: black;">这般</span>在24小时之内，<span style="color: black;">一般</span>这种腹泻都能得到<span style="color: black;">掌控</span>。</span><span style="color: black;">还有一种<span style="color: black;">状况</span>提示，可能是肿瘤在<span style="color: black;">发展</span>，<span style="color: black;">意见</span>到医院去做个腹部X光片，进一步确诊。再有一种<span style="color: black;">状况</span>可能是<span style="color: black;">初期</span>的不全梗阻，<span style="color: black;">亦</span><span style="color: black;">必须</span>到医院进一步确诊。<span style="color: black;">倘若</span>是不全梗阻的话，可能<span style="color: black;">必须</span>更换治疗<span style="color: black;">方法</span>，或采取<span style="color: black;">有些</span><span style="color: black;">办法</span>来解除梗阻。</span><span style="color: black;"><strong style="color: blue;">网友：</strong><strong style="color: blue;">直肠癌术后</strong><strong style="color: blue;">5</strong><strong style="color: blue;">年多，肝转术后</strong><strong style="color: blue;">3</strong><strong style="color: blue;">年多，安慰性治疗</strong><strong style="color: blue;">4</strong><strong style="color: blue;">年多，<span style="color: black;">日前</span>病情比较稳定。</strong><strong style="color: blue;">在去年</strong><strong style="color: blue;">3</strong><strong style="color: blue;">月做了心脏支架、吃阿司匹林和抗凝药，请问吃抗凝药和贝伐单抗靶向治疗能<span style="color: black;">同期</span>进行吗？</strong></span><span style="color: black;">李进教授：<span style="color: black;">倘若</span>是肝转移和其他病灶得到<span style="color: black;">掌控</span>的话，抗凝药和贝伐单抗<span style="color: black;">能够</span><span style="color: black;">同期</span>应用。但要<span style="color: black;">重视</span><span style="color: black;">流血</span>，如鼻<span style="color: black;">流血</span>、便血<span style="color: black;">或</span>其他部位有<span style="color: black;">流血</span>，这两种药可能会加重<span style="color: black;">流血</span>。你<span style="color: black;">已然</span>用贝伐单抗<span style="color: black;">已然</span>4年多，说明病情得到了很好的<span style="color: black;">掌控</span>。<span style="color: black;">倘若</span>肝脏转移还有病灶的话，<span style="color: black;">意见</span>用局部治疗的<span style="color: black;">办法</span>把病灶清除掉。<span style="color: black;">倘若</span><span style="color: black;">已然</span><span style="color: black;">无</span>病灶了，贝伐珠单抗<span style="color: black;">无</span>必要再用。</span><span style="color: black;"><strong style="color: blue;">网友：</strong><strong style="color: blue;">去年</strong><strong style="color: blue;">12</strong><strong style="color: blue;">月做的结肠肿瘤手术，当时还<span style="color: black;">发掘</span>了阑尾神经内分泌瘤，这一<span style="color: black;">周期</span>严重吗？</strong></span><span style="color: black;">李进教授：大肠癌<span style="color: black;">倘若</span><span style="color: black;">无</span>淋巴结转移，<span style="color: black;">同期</span>肿瘤<span style="color: black;">处在</span>很<span style="color: black;">初期</span>，那<span style="color: black;">能够</span>观察。<span style="color: black;">倘若</span>肿瘤侵犯到T3以上，<span style="color: black;">必须</span>用卡培他滨做辅助治疗，<span style="color: black;">每日</span>吃两次，每次3粒1.5克，连续吃两周，<span style="color: black;">而后</span>停<span style="color: black;">1星期</span>，<span style="color: black;">这般</span>的<span style="color: black;">办法</span>来做治疗。</span><span style="color: black;"><span style="color: black;">倘若</span>肿瘤的病灶是T1、T2，<span style="color: black;">那样</span>不<span style="color: black;">必须</span>做任何治疗，在家里观察就<span style="color: black;">能够</span>。这个<span style="color: black;">办法</span><span style="color: black;">能够</span>暂时<span style="color: black;">掌控</span>一两个月，应该<span style="color: black;">无</span>太大问题，等疫情过后，再到医院，<span style="color: black;">按照</span><span style="color: black;">此刻</span>的病理报告，去做相应的治疗。</span><span style="color: black;">阑尾神经内分泌估计是比较轻的，<span style="color: black;">由于</span>神经内分泌肿瘤还分三级，<span style="color: black;">倘若</span>是一级、二级，不<span style="color: black;">必须</span>做辅助治疗。<span style="color: black;">仅有</span>三级才<span style="color: black;">必须</span>做治疗，<span style="color: black;">况且</span>内分泌肿瘤对化疗比较抵抗，还是应该<span style="color: black;">重点</span>关注大肠方面的问题。</span><span style="color: black;"><strong style="color: blue;">网友：</strong><strong style="color: blue;">我父亲年前做了结直肠癌右半切显手术，病理报告上<span style="color: black;">表示</span>神经侵犯是加号，这种<span style="color: black;">状况</span><span style="color: black;">必须</span>做化疗吗？</strong></span><span style="color: black;">李进教授：<span style="color: black;">必须</span>做术后辅助化疗，用奥沙利铂联合氟尿嘧啶或卡培他滨的治疗<span style="color: black;">方法</span>。<span style="color: black;">倘若</span>仅仅是说有神经侵犯，<span style="color: black;">无</span>淋巴结转移，<span style="color: black;">况且</span>肿瘤分期不是<span style="color: black;">尤其</span>晚，只做3次到4次的联合化疗就<span style="color: black;">能够</span>了。但<span style="color: black;">倘若</span>淋巴结转移数量比较多，超过6个以上了，这个时候的联合辅助化疗就<span style="color: black;">必要</span>做满6个月。</span><span style="color: black;"><strong style="color: blue;">网友：</strong><strong style="color: blue;">结肠癌术后化疗完<span style="color: black;">成为了</span></strong><strong style="color: blue;">8</strong><strong style="color: blue;">次。</strong><strong style="color: blue;"><span style="color: black;">因为</span>疫情影响，第</strong><strong style="color: blue;">9</strong><strong style="color: blue;">次贝伐珠单抗的时间估计会错后两个月，只能用卡培他滨，<span style="color: black;">是不是</span><span style="color: black;">有害</span>于病情的<span style="color: black;">掌控</span>？</strong></span><span style="color: black;">李进教授：从<span style="color: black;">病人</span>描述的病情来看，肿瘤切除后可能其他部位还有转移病灶存在，<span style="color: black;">因此</span>他给你用了化疗联合靶向，疫情<span style="color: black;">时期</span><span style="color: black;">倘若</span>没办法用静脉用药的<span style="color: black;">办法</span>，<span style="color: black;">能够</span>单独用卡培他滨。<span style="color: black;">倘若</span><span style="color: black;">大夫</span>愿意用贝伐珠单抗跟卡培他滨来做维持治疗，我觉得更好。等<span style="color: black;">一月</span>后，<span style="color: black;">倘若</span>疫情基本上没问题了，再继续用原来的标准治疗<span style="color: black;">方法</span>。</span><span style="color: black;">随后，<span style="color: black;">意见</span>每两个月做一次CT和磁共振，<span style="color: black;">评定</span>治疗效果。<span style="color: black;">倘若</span>疗效稳定，病灶<span style="color: black;">掌控</span>得很好，<span style="color: black;">或</span>肿瘤<span style="color: black;">乃至</span>还缩小了，<span style="color: black;">那样</span>这种<span style="color: black;">方法</span>继续做。<span style="color: black;">倘若</span><span style="color: black;">发掘</span>肿瘤的直径之和超过了原来的20%，那就说明病情在<span style="color: black;">发展</span>，这个时候就要换化疗<span style="color: black;">方法</span>了。</span><span style="color: black;"><strong style="color: blue;">网友：</strong><strong style="color: blue;">我的父亲春节前确诊了结肠癌，<span style="color: black;">由于</span>疫情手术延迟，<span style="color: black;">此刻</span><span style="color: black;">显现</span>排便次数<span style="color: black;">增加</span>，这种<span style="color: black;">状况</span>下该怎么办？</strong></span><span style="color: black;">李进教授：结肠癌<span style="color: black;">病人</span>大便次数<span style="color: black;">增加</span>，可能跟肿瘤<span style="color: black;">发展</span><span style="color: black;">相关</span>系。我<span style="color: black;">意见</span>，<span style="color: black;">倘若</span>能做手术的话，应尽快手术治疗。<span style="color: black;">倘若</span>实在没办法手术，先去做化疗，用奥沙利铂加卡培他滨，三个星期一次，只要到医院去打一次针，<span style="color: black;">而后</span>回家吃卡培他滨就<span style="color: black;">能够</span>了，等到能做手术了再去手术。</span><span style="color: black;"><strong style="color: blue;">网友：</strong><strong style="color: blue;">我的大便基本上是一天</strong><strong style="color: blue;">4~5</strong><strong style="color: blue;">次，<span style="color: black;">已然</span><span style="color: black;">连续</span>一年<span style="color: black;">上下</span>了，平时<span style="color: black;">爱好</span>吃辛辣重口味的<span style="color: black;">食品</span>，年前去做了体检，请问还<span style="color: black;">必须</span>做肠镜吗？</strong></span><span style="color: black;">李进教授：要做的。肠癌<span style="color: black;">常常</span>跟大便习惯的改变<span style="color: black;">相关</span>系，像便秘、腹泻，或是脓血便、大便带血，这种<span style="color: black;">状况</span>都要高度提示肠癌的可能性。<span style="color: black;">由于</span>你<span style="color: black;">爱好</span>吃辛辣的食品，我相信不是一两天，<span style="color: black;">亦</span>不是两三个月的时间，<span style="color: black;">倘若</span>以前吃辛辣<span style="color: black;">食品</span><span style="color: black;">无</span>腹泻，但<span style="color: black;">此刻</span>腹泻了，要高度<span style="color: black;">警觉</span>肠癌的可能性，当然<span style="color: black;">亦</span>可能是肠炎，或是息肉，<span style="color: black;">必须</span>做个肠镜看一下。</span><span style="color: black;"><strong style="color: blue;">网友：</strong><strong style="color: blue;">我是湖北的<span style="color: black;">病人</span>，</strong><strong style="color: blue;">直肠癌<span style="color: black;">已然</span>口服化疗三个疗程，放疗一个疗程，<span style="color: black;">近期</span>两天<span style="color: black;">显现</span>了便血，血色为鲜红色，但<span style="color: black;">日前</span><span style="color: black;">没</span>法<span style="color: black;">看病</span>，<span style="color: black;">是不是</span><span style="color: black;">能够</span>先口服什么药？</strong></span><span style="color: black;">李进教授：<span style="color: black;">倘若</span>有便血，可能是肠癌病情在<span style="color: black;">发展</span>，光用口服<span style="color: black;">药品</span><span style="color: black;">掌控</span>不住。<span style="color: black;">倘若</span>没做过手术，我<span style="color: black;">意见</span>抓紧时间去<span style="color: black;">看病</span>。口服卡培他滨，还<span style="color: black;">能够</span>继续吃，毕竟它还是有<span style="color: black;">掌控</span><span style="color: black;">功效</span>。还<span style="color: black;">能够</span>口服一点止血药，<span style="color: black;">而后</span>多点点香蕉、麻油，不要吃硬的<span style="color: black;">食品</span>，像蔬菜，吃叶子，不要吃梗，再<span style="color: black;">协同</span>吃点番泻叶、中药麻仁丸<span style="color: black;">亦</span><span style="color: black;">能够</span>，<span style="color: black;">这般</span><span style="color: black;">每日</span>3~4次的大便，稀软一点，减少大便干结摩擦肿瘤，减轻<span style="color: black;">流血</span>状态。等疫情有所<span style="color: black;">掌控</span>的时候，要抓紧时间去做联合化疗，或是手术治疗、局部的放疗。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/oZVJebibh9Rne2jqrapnN8z0tFqubbKtRn8cIJFCXXCQ2jiad4cE0PhfwpZvNMqShNfF4XVCiamvwicZE0zwDDus3A/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/oZVJebibh9Rne2jqrapnN8z0tFqubbKtRY6jGopWdgQ1IJj05CMO9yheXQTX6CyDOZ8J8riaOsCj6GadNiaNTwW9g/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">（PS：管理员繁忙，请备注癌种、<span style="color: black;">经过</span>验证后方可入群）</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_png/oZVJebibh9Rne2jqrapnN8z0tFqubbKtRDlib2HWy91VAoWIW60aw5kGbTic6rJJAbmuIWZLSy45vHllOlAlBm1BA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/oZVJebibh9Rne2jqrapnN8z0tFqubbKtRJYY8YM4F1zA5xugLuof03FKIjabEcLNIQbZGF9VcxkibicibPQG5knndw/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌症<span style="color: black;">病人</span>如治疗遇到困境，想参加临床<span style="color: black;">实验</span>，可点击文末<span style="color: black;"><strong style="color: blue;">“阅读原文”</strong></span>提交病情，<span style="color: black;">咱们</span>会帮您<span style="color: black;">举荐</span>申请合适的临床<span style="color: black;">实验</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">翳安健康专注于肿瘤<span style="color: black;">行业</span>，<span style="color: black;">经过</span><span style="color: black;">微X</span>公众号“找药宝典”、“国际肝胆<span style="color: black;">新闻</span>”等多个平台，为该<span style="color: black;">行业</span>的<span style="color: black;">病人</span>在<span style="color: black;">全世界</span>范围内寻求最有效的治疗手段。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">咱们</span><span style="color: black;">经过</span><span style="color: black;">供给</span>癌症临床<span style="color: black;">实验</span>招募，海外<span style="color: black;">看病</span>服务、基因检测援助、搭建<span style="color: black;">病人</span>讨论平台等多项服务，为更好<span style="color: black;">处理</span><span style="color: black;">病人</span>在抗癌路上面临的困境而<span style="color: black;">奋斗</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">癌症可怕，但<span style="color: black;">咱们</span>与您携手抗癌！</p>
我完全赞同你的观点，思考很有深度。
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