难治性复发肝肿瘤的肝移植

Liver transplantation for treatment of refractory recurrent liver neoplasm

目的探讨难治性复发肝肿瘤行肝移植的难点及围手术期处理注意事项。方法总结2003年9月至2004年9月我科施行的14例肝移植,其中难治性复发肝肿瘤9例(A组),其余5例术前未接受任何有创治疗(B组),分析两组术前治疗情况、术中探查情况、病肝游离时间、无肝期时间、术中出血、输血及止血药物使用情况、手术死亡率、术后肾上腺糖皮质激素的减撤及化疗等情况。结果A组术中病肝游离时间、无肝期时间明显较B组长,出血、输血量及止血药物的用量均明显大于B组,手术死亡2例均为A组病例。术后存活的肝癌病例均行全身化疗,肾上腺糖皮质激素于3个月内停药,至今均无瘤生存。结论难治性复发肝肿瘤的肝移植较一般肝移植手术难度大,对术者要求更高,术中监护和补充凝血因子极为重要。围手术期抗肿瘤治疗、术后尽早减撤肾上腺糖皮质激素对术后无瘤生存有积极意义。

Objective To explore the difficulty of liver transplantation for refractory recurrent liver neoplasm and determine the problems that should be noted during the perioperative period. Methods The clinical data of 14 patients receiving liver transplantation in our hospital from September 2003 to September 2004 were retrospectively analyzed. Of the 14 patients, 9 had suffered from refractory recurrent liver neoplasm （group A） and 5 had not been treated by any wounded therapy （group B）. The preoperative treatment, intraoperative exploration, time for dissociating the recipient＇s liver, time of anhepatic phase, intraoperative bleeding, intraoperative blood transfusion, dosage of hemostatic drug, operative mortality, scheme of glucocorticoid and auxiliary chemotherapy were determined in and compared between the 2 groups. Results The time for dissociating the recipient＇s liver and that of anhepatic phase were significantly longer and the volume of intraoperative bleeding, intraoperative blood transfusion and dosage of hemostatic drug markedly higher in group A than in group B. Two patients of group A died postoperatively. All the surviving cases with liver cancer before transplantation achieved postoperative chemotherapy and the glucocorticoid was withdrawn within 3 months and they have a tumor-free survival now. Conclusions The liver transplantation for the refractory recurrent liver neoplasm is more difficult than that for others. The close intraoperative monitoring and supply of blood clotting factors are very important. The perioperative anti-tumor treatment and early withdrawal of glucocorticoid are of positive significance for tumor-free survival of patients after transplantation.