肝癌肝移植术后肿瘤复发的治疗策略  

Strategies of treatments for tumor recurrence of liver cancer after liver transplantation

作　　者：邱春辉[1] 赵辉[1] 陈湖岸[1] 陈颖华[1] 孟炜[1] 许赤[1] 易述红[1] 李华[1] 汪根树[1] 张剑[1] 杨扬[1] 蔡常洁[1] 陆敏强[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝移植中心,广州510630

出　　处：《中华普通外科学文献（电子版）》2011年第4期33-36,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：国家博士基金项目(20090171110071);广州市科技项目(2009Z1-E211)

摘　　要：目的比较肝癌肝移植术后肝内复发的患者分别实施肿瘤切除术、经导管肝动脉灌注化疗栓塞术(TACE)、射频消融术(RFA)、再次原位肝移植术(re-OLT)的临床疗效。方法回顾性分析我中心2004年1月至2009年6月因肝癌行肝移植手术术后肝内复发的患者53例。其中肿瘤切除术3例,TACE22例,RFA18例,re-OLT10例,观察术前一般情况、术后生存时间、术后并发症、肿瘤进展情况、治疗费用等情况。重点对比分析TACE、RFA、re-OLT三种治疗方法的疗效。结果肿瘤切除术3例,随访4～12个月,均无手术并发症,未见肝脏及远处复发或转移,一般情况良好。TACE组、RFA组与re-OLT组的平均生存时间、累积生存率、各部位进展情况的差异无统计学意义;RFA组的并发症,特别是胆道并发症发生率比TACE组及re-OLT组低;3组的治疗费用的差异有统计学意义,RFA<TACE<re-OLT。结论 TACE、RFA及re-OLT治疗方法对肝癌肝移植术后肝内复发的治疗效果相近。RFA的并发症及治疗费用明显少于TACE及re-OLT,可作为肝癌肝移植术后肝内复发的首选治疗方案。Objective To investigate pre-treatment condition, mean survival time, survival rate, tumor progression condition, complications and treatment cost of transcatheter arterial chemoembolization （TACE）, radiofrequency ablation（RFA） and orthotopic liver retransplantation（re-OLT）. Methods Retrospective analysis of 53 cases reported for intrahepatic recurrence after liver transplantation of our hospital, from Jan. 2004 to Jun. 2009. There were 3 patients received surgical resection, 22 for TACE, 18 for RFA and 10 for re-OLT. The pre-treatment condition, survival time, tumor progression condition, complications and treatment cost of the patients of surgical resection are investigated. Treatment effect of the patients received TACE, RFA and re-OLT were compared and analyzed. Results Three patients received surgical resection. After 4-12 months follow-up, they had not been found complications and tumor progression, and they were still alive. The difference of mean survival time, survival rates and the tumor progression condition among TACE, RFA and re-OLT are considered no significant; But RFA was lower in severe degree of complication, especially the biliary complications, and the cost of treatment： RFA 〈TACE 〈re-OLT. Conclusions The curative effect among TACE, RFA and re-OLT are similar to one other in curing the tumor recurrence of liver cancer after liver transplantation. RFA is much lower than TACE and re-OLT in severe degree of complication and the cost of treatment.

关 键 词：肝癌 肝移植 复发 治疗 

分 类 号：R735.7[医药卫生—肿瘤]