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目的 探讨腔静脉成形背驮式肝移植治疗原发性肝癌的效果。方法 对32 例乙型肝炎肝硬化、原发性肝癌患者施行腔静脉成形背驮式肝移植,其临床分期,Ⅱa期1 例,Ⅱb期22 例,Ⅲ期9例。术中证实门静脉癌栓11例,胆管癌栓3例,下腔静脉和/或肝静脉癌栓6 例;对于瘤体较大者,术中行射频处理,Ⅲ期患者术中均进行12、8、9、16、13、14 组淋巴结清扫;对于瘤体较大及术后甲胎蛋白处于高水平者进行化疗;术后采用他克莫司及泼尼松预防排斥反应。结果 手术历时(8.5±2.1)h,无肝期(60±25)min,失血量(800±450)ml;术后存活时间超过6个月者30 例(93.8 %),超过12个月者26例(81.3 %),超过18个月者18例(56.3 %),存活时间最长者26个月;Ⅱa、Ⅱb期患者术后无瘤时间平均为11.5个月,存活时间为15 个月;Ⅲ期患者存活8~15 个月;围手术期无患者死亡,未发生与腔静脉成形术相关的流出道梗阻,无因术后出血需手术探查及肾功能衰竭病例。结论 腔静脉成形背驮式肝移植可作为乙型肝炎肝硬化、原发性肝癌的有效治疗手段。
Objective To investigate the effect of piggyback piggyback liver transplantation on primary liver cancer. Methods 32 cases of hepatitis B cirrhosis and primary hepatocellular carcinoma were treated with vena cava piggyback liver transplantation. There were 1 case of stage Ⅱa, 22 cases of stage Ⅱb and 9 cases of stage Ⅲ. Intraoperative confirmed thrombosis in 11 cases of portal vein, cholangiocarcinoma suppository in 3 cases, inferior vena cava and / or hepatic vein tumor thrombus in 6 cases; for the larger tumor, intraoperative radiofrequency ablation, stage Ⅲ patients were surgery 12,8 , 9, 16, 13, and 14 lymph node dissection; chemotherapy for patients with large tumor and high level of alpha-fetoprotein after surgery; and prevention of rejection after tacrolimus and prednisone. Results The duration of operation was (8.5 ± 2.1) h, the period of anhepatic period was (60 ± 25) min and the blood loss was (800 ± 450) ml. Thirty patients (93.8%) survived more than 6 months after operation, 26 cases (81.3%), more than 18 months in 18 cases (56.3%), the longest survival time of 26 months; Ⅱ a, Ⅱ b patients with postoperative tumor-free time average of 11.5 months, the survival time of 15 months ; Stage Ⅲ patients survived 8 to 15 months; no perioperative deaths, no outflow tract obstruction associated with vena cava angioplasty, no postoperative bleeding requiring surgical exploration and renal failure cases. Conclusions The piggyback piggyback liver transplantation can be used as an effective treatment for hepatitis B cirrhosis and primary liver cancer.