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目的观察肝移植治疗原发性肝癌肝切除术后复发患者的疗效。方法回顾性分析11例原发性肝癌肝切除术后复发接受经典原位肝移植治疗的受者的临床资料,观察移植效果。结果在围手术期,1例术后发生移植肝功能不全和凝血功能障碍并发肾功能衰竭死亡;1例术后出现急性胰腺炎,给予生长抑素治疗10 d缓解;2例发生急性排斥反应,行大剂量甲泼尼龙冲击治疗3 d逆转。10例受者顺利出院。出院后,3例分别于术后第5个月、第7个月、第19个月死于肝癌复发,1、2年受者存活率分别为72.7%(8/11)和63.6%(7/11),至今最长存活的1例已达4年余。获长期存活的受者肝癌肝切除术前原发病均为小肝癌,肝切除术后复发行肝移植时肝癌均符合Milan标准。结论小肝癌行肝癌肝切除术后应密切随访,如发现肝癌复发且符合Milan标准可考虑行肝移植治疗,患者仍有可能获较长时间生存。
Objective To observe the curative effect of liver transplantation in patients with recurrent hepatocellular carcinoma after hepatectomy. Methods The clinical data of 11 recipients who had undergone classic orthotopic liver transplantation after resection of primary liver cancer were retrospectively analyzed. The effect of transplantation was observed. Results In the perioperative period, one patient had liver dysfunction and coagulation dysfunction with renal failure after operation. One patient had acute pancreatitis after operation and was treated with somatostatin for 10 days. Two patients developed acute rejection, High-dose methylprednisolone impact treatment 3 d reverse. Ten patients were discharged successfully. After discharge from the hospital, 3 patients died of recurrence of liver cancer at the 5th, 7th and 19th months after operation, respectively. The survival rates at 1 and 2 years were 72.7% (8/11) and 63.6% (7) / 11), one of the longest survival so far has been more than 4 years. The recipients of long-term survival of liver cancer before surgery are primary liver disease, recurrent liver transplantation liver transplantation are in line with the Milan standard. Conclusions Small hepatocellular carcinoma should be closely followed after hepatectomy. If recurrence of hepatocellular carcinoma is found and meets the criteria of Milan, liver transplantation may be considered, and patients may still have a longer survival time.