肝癌肝移植的适应证及疗效评价

肝切除是肝癌最常用的治疗手段。但是由于肝功能不全等因素，很多患者在诊断肝癌时已丧失了手术机会。肝移植不仅清除了肿瘤而且去除了硬化的肝脏，因此对早期肝癌伴有肝功能不全的患者，是理想的治疗方式。对肝癌肝移植来说，适应证的选择是影响术后肝癌复发及远期疗效的最关键因素。米兰标准则是最常用的纳入标准，按此标准进行肝癌肝移植5年生存率大于60．0％，效果良好。但米兰标准也存在局限性，更多的研究主张扩大米兰标准，建立新的标准。在我国，一些学者结合国人肝癌的特点提出了自己的标准，这些标准扩大了肝癌肝移植的适应证，且并未降低术后生存率，但有待进一步验证并形成相对统一的中国标准。另外，采用合理的综合治疗手段，预防肝癌的复发亦有待进一步的研究和探讨。

Indications and outcome of liver transplantation for hepatoceUular carcinoma

Liver resection is the most available, efficient treatment for patients with hepatocellular carcinoma. Howerver, most HCCs are unresectable at diagnosis due to poor liver fuctions of the patients, laver transplantation leads to removal of the tumor and the remaining cirrhotic liver. Transplantation is hence an ideal treatment for early HCC patients with poor liver function. Choosing optimal indications is the most critical factor that affects postoperative cancer recurrence and long-term outcome. Milan criteria are the most common used standard with a 5-years survival rate greater than 60.0%. To overcome the limitations of the Milan criteria, there are still a considerable number of studies dedicated to expanding the Milan criteria and some new criteria have also been well established. In our country, some researchers proposed their own standards based on the characteristics of HCC in Chinese people. At present, several established Chinese liver transplantation standards for HCC significantly broaden the indications for liver transplantation, without compromising survival rates and disease-free survival. But these are still needed to be supported by high levels of evidence based on medicine. Thus, a relative unified Chinese standard is required to be formed. In addition, using reasonable means to prevent the recurrence of liver cancer also needs further study and discussion.