肝移植治疗原发性肝细胞癌的进展

Progress on Liver Transplantation for Primary Hepatocellular Carcinoma

肝移植已经成为治疗肝癌的重要手段。选择合适的病人是一个重要的问题,国际通行的是米兰标准,我国一般公认的适应证主要包括:合并有肝硬变失代偿、不能接受肝切除治疗的小肝癌患者和肿瘤多发且波及左右两叶、肝功能严重损害、行切除术后肿瘤容易复发或出现肝功能衰竭者。血管侵犯,细胞分化程度等因素可以影响治疗的预后。围手术期辅助治疗(经皮肝动脉化学栓塞、经皮无水酒精瘤内注射、射频消融,氩氦刀治疗)对于提高肝移植的疗效有一定的意义。

Total hepatectomy with transplantation has been accepted as the important treatment for hepatocellular carcinoma(HCC). Selecting optimal candidates is a key point in the attempt to a better outcome of transplantation for HCC. Milan criteria has been accepted internationally. In China, the indication generally accepted is: small HCC patient with poor liver function and with severe cirrhosis or patient precluding hepatic resection with tumor involved both sides of the liver. Some factors, such as vascular invasion or tumor differentiation has been recognized as prognostic factor of transplantation for HCC. Many pre- and post-operative managements such as transcatheter arterial chemoembolization(TACE),percutaneous ethanol injection therapy(PEIT),radiofrequency ablation(RFA),etc can improve the result of transplantation for HCC.