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肝切除术是目前治疗肝癌的常规方法,但有较高的肿瘤复发率。肝移植则主要针对不能切除的肝癌、同时伴有肝功能不良者。但由于供肝的缺乏,许多学者提倡先行肝切除,待肿瘤复发后再行补救性肝移植。对于首选一期肝移植还是一期肝切除、补救性肝移植一直以来有较大争议。国外多数移植中心遵循米兰标准施行补救性肝移植,肝切除术后肿瘤复发后,仅部分病人获补救性肝移植。各项回顾性或意向处理分析研究结果显示,一期行肝切除术后行补救性肝移植在总的存活率方面与一期肝移植术相似,但目前仍缺乏前瞻性研究数据的支持。目前的共识是对肝功能储备较好、年龄较大的肝癌病人可首选肝切除,对其中部分肝癌复发者再施行补救性肝移植治疗。
Hepatectomy is currently the conventional treatment of liver cancer, but has a high rate of tumor recurrence. Liver transplantation is mainly for unresectable liver cancer, accompanied by liver dysfunction. However, due to the lack of donor liver, many scholars advocate the first hepatectomy until the recurrence of tumor recurrence after liver transplantation. For the first phase of a liver transplant or a hepatectomy, resection of liver transplantation has been more controversial. Most foreign transplant centers follow the Milan standards for the implementation of recuperative liver transplantation, tumor recurrence after liver resection, only part of the patients were rescued liver transplantation. Retrospective or intentional analysis of the results of the analysis showed that the first phase of resection of the liver after resection of the overall survival in the survival rate with a phase of liver transplantation is similar, but the lack of prospective data support. The current consensus is that the reserve of liver function is better, the older patients with liver cancer may be the preferred hepatectomy, and some patients with recurrent liver cancer will be treated with salvage liver transplantation again.