中国实用外科杂志

中国实用外科杂志 ›› 2012, Vol. 32 ›› Issue (10): 826-829.

• 专题笔谈 • 上一篇    下一篇

肝癌肝切除术后复发的补救性肝移植治疗

陈    皓，彭承宏   

  1. 上海交通大学医学院附属瑞金医院外科，上海200025
  • 出版日期:2012-10-01 发布日期:2012-09-28

  • Online:2012-10-01 Published:2012-09-28

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摘要：

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。

关键词: 肝癌, 肝切除, 补救性肝移植

Abstract:

Salvage liver transplantation for the treatment of recurrent liver cancer after hepatectomy        CHEN Hao, PENG Cheng-hong. Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200025, China
Corresponding author: PENG Cheng-hong, E-mail: chhpeng@188.com
Abstract    Hepatectomy is the mainstay of treatment for hepatocellular carcinoma (HCC) though higher rate of recurrence exists. Liver transplantation is the treatment option for patients with unresectable tumors associated with hepatic malfunction. However, some authors have advocated salvage liver transplantation even for the recurrence of HCC after hepatectomy due to shortage of donor. The first choice of primary hepatectomy or liver transplantation has been argued for recent years. Milan criteria have been obeyed for the performance of salvage transplantation in the most of transplant centers. Only small part of patients have chance to receive salvage transplantation after the recurrence of HCC. Many retrospective investigation or studies of intention-to-treat analysis have revealed that there was similar rate of long survival between primary liver transplantation and salvage transplantation. However, such result has not been confirmed by the data from prospective studies. The consensus is that primary hepatectomy for HCC should be chosen for elder patients associated with good liver function and salvage transplantation could be performed when recurrence occurs.

Key words: hepatocellular carcinoma, hepatectomy, salvage liver transplantation