肝移植治疗原发性肝癌切除术后肝内复发七例

Liver transplantation for recurrence of primary liver cancer after resection

目的探讨对原发性肝癌切除术后肝内复发患者进行肝移植手术的适应证和围手术期的治疗经验。方法回顾性分析2000年9月至2005年9月间7例原发性肝癌切除术后肝内复发的患者接受原位肝移植治疗的临床资料，其中男性6例，女性1例，平均年龄43．7岁，肝移植术前均经病理学检查确诊为原发性肝癌，肿瘤组织学分级为高、中分化，肝癌切除术后无瘤期为6～31个月，均未发生肿瘤细胞侵犯大血管和肝外转移。所有患者均采用改良背驮式肝移植术。术后采用他克莫司（或西罗莫司）＋霉酚酸酯＋激素的三联免疫抑制方案。观察肝移植术后受者并发症及存活率情况。总结肝移植治疗原发性肝癌切除术后肝内复发的经验。结果所有受者肝移植手术过程顺利，围手术期无死亡。1例术后22h发生腹腔出血，1例术后13d发生腹腔感染，1例术后4个月发生门静脉血栓，其余未发生严重并发症，7例受者均顺利出院。有3例受者分别于移植术后9、13及19个月时，因肿瘤复发而死亡，其余4例均长期无瘤存活，最长已达52个月。受者的1、2年存活率分别为85．7％和57．1％。结论肝移植能有效治疗原发性肝癌切除术后肝内复发，受者适应证的选择和同手术期的辅助治疗非常关键。

Objective To study the indication and treatment of liver transplantation for the patients with recurrence after resection of liver cancer. Methods The clinical data of 7 patients with re currence after tumor resection of primary liver cancer receiving liver transplantation between Sep. 2000 and Sep. 2005 were analyzed retrospectively. Among them, 6 cases were male and 1 female with the average age of 43.7 years old. Before liver transplantation, primary liver cancer was proven by pathology and the histological types of tumors were well and middle differentiated. The tumor free interval after partial hepatectomy for primary liver cancer was 6-31 months. There were no large vasculature invasion by tumor and extrahepatic metastasis before liver transplantation. All the patients received modified piggy-back liver transplantation and were subjected to immunosuppressive therapy of tacrolimus （or sirolimus） ＋ mycophenolate mofetil ＋ steroid. The complication and survival rate after liver transplantation was observed. The experience of liver transplantation for recurrence of primary liver cancer after resection was analyzed. Results There was no perioperative death in 7 patients. The main complications after operation included abdominal hemorrhage （1 case） at 22 h, abdominal infection （1 case） on the 13th day and portal vein thrombosis （1 case） on the 4th month. Three patients were died of tumor recurrence at 9th, 13th and 19th month after liver transplantation. Up to now, the remaining patients survived and had no recurrence, and the longest survival time was 52 months. In the 7 patients, 1- and 2 year survival rate was 85.7% （6/7） and 57. 1% （4/7）, respectively. Conclusion I.iver transplantation is an effective therapy for the patients with recurrence after resection of liver cancer. The selection of the indications and the adjuvant therapy during operation are very important.