肝移植治疗肝转移癌的临床分析

Clinical analysis of liver transplantation in treatment of liver metastatic cancer

目的探讨肝移植治疗肝转移癌的可行性和效果。方法4例经病理证实的肝转移癌患者实施了肝移植术，其中胰腺神经内分泌肿瘤肝转移1例．直肠神经内分泌肿瘤肝转移1例，胃间质瘤肝转移1例，结肠癌肝转移1例。手术方式均为经典式原位肝移植术，供体均为尸体供肝。结果4例患者肝移植手术顺利，术后早期恢复好，且生活质量良好。胰腺内分泌肿瘤肝转移患者移植术后4年半，肝脏肿瘤复发，行肝左外叶切除术，至今无瘤生存。直肠神经内分泌肿瘤肝转移患者术后16个月发现右肾及盆腔肿瘤转移．术后5年死于肿瘤复发。胃间质瘤肝转移患者术后5个半月发现盆腔广泛转移，带瘤生存4年半。结肠癌肝转移患者术后3个月双肺广泛转移，术后1年半死亡。结论经过严格筛选，肝移植可作为部分分化较好的、不能手术切除的肝转移癌患者的一种治疗选择，并可能获得较好的治疗效果。

Objective To evaluate the feasibility and outcome of liver transplantation in the treatment of liver metastatic cancer. Methods Four patients with pathologically confirmed liver metastatic cancer underwent liver transplantation, including one of liver metastases from pancreatic endocrine tumor, one from rectal endocrine tumor, one from stomach stromal tumor and one from colorectal carcinoma. Classic surgical method was adopted, i.e. orthotopic liver transplantation for the recipients and transplants came from cadaveric donors. Results All the four patients had a smooth operation, an uneventful early postoperative recovery and good living quality. The patient with liver metastases from pancreatic endocrine tumor had liver tumor recurrence at four and a half years after the transplantation, and then underwent left lateral hepatic lobectomy, without any recurrence until now. The patient with liver metastases from rectal endocrine tumor had right renal amt pelvic tumor metastasis at 16 months after the operation, and died of tumor recurrence 5 years after the liver transplantation. The patient with liver metastases from gastric stromal tumor had extensive pelvic metastases at five and a half months after the transplantation, and survived with tumor for 4 years and 6 months after the operation. The patient with liver metastases from colorectal carcinoma had extensive bilateral lung metastases at 3 months after the transplantation and died one and a half years after the operation. Conclusion For well-differentiated unresectable metastatic liver cancers, liver transplantation may serve as a treatment option and better treatment results can be achieved for some highly selected patients.