原发性肝癌肝移植术后化疗效果的初步观察

Chemotherapy of Primary Liver Carcinoma undergoing Liver Transplantation

目的:探讨原发性肝癌肝移植后化疗的安全性和疗效。方法:回顾性分析22例因原发性肝癌而行肝移植病人的临床资料,以求进一步探明肝癌的肝移植指征,术后化疗时机、化疗方案、化疗的副作用及化疗对近、远期生存率的影响。结果:2002年6月至2003年7月,共有22例原发性肝癌进行肝移植;18例最迟于术后5周内进行第1次全身化疗,累计完成化疗41次;其余4例因各种原因未行化疗,包括1例意外发现的癌和1例小肝癌。8例出现肝功能损害,6例发生白细胞减少,仅2例需重组人集落刺激生长因子治疗。结论:原发性肝癌是肝移植的一个主要适应证;结合术后化疗可延长复发时间,提高生存率;且病人可以安全耐受。

Objective: To explore the effect of systemic chemotherapy of primary liver carcinoma undergoing liver transplantation. Methods: All cases of primary liver carcionoma undergoing liver transplantation in our hospital were retrospectively analyzed. The indication for liver transplantation, the time and schedule of chemotherapy and its effect on short-term and long-term survival rate were studied. Results: From June 2002 to July 2003, 22 patients with primary hepatic carcinoma underwent liver transplantation. Eighteen patients received systemic chemotherapy every 4 weeks as tolerated, starting from the fifth postoperative week. Four cases did not have chemotherapy due to various reasons, including 1 case of accidentally discovered HCC and 1 case of small HCC. Among the patients receiving chemotherapy, 8 cases showed liver functional disorder, 6 had bone marrow depression, of witch only 2 cases need granulocyte colony-stimulating factor with no adverse effect on graft tolerance. Conclusions: Primary liver carcinoma remains one of the major indications of liver transplantation in China. Postoperative chemotherapy is usually well tolerated, and seems to deter recurrence and prolong survival in patients undergoing liver transplantation.