肝癌切除术后复发患者行肝移植后移植肝再发肝癌的治疗对策——一例长期存活病例报道并相关文献复习

目的总结原发性肝癌切除术后复发患者行肝移植后新肝再发肝癌的治疗经验。方法 2003年11月14日空军总医院肝胆外科为1例肝癌切除术后复发患者施行了同种异体原位肝移植。肝移植术后（以下简称术后）3个月时曾返院化疗。术后19个月时发现移植肝首次出现肝癌复发,随后依次施行经皮肝穿刺射频消融、肝动脉化疗栓塞、术中射频消融及肝左内叶肿瘤切除术等序贯综合治疗。术后32个月时发现移植肝再次复发肝癌,依次给予经肝动脉化疗栓塞、术中肝右前叶肿瘤射频治疗及肝右后叶肿瘤切除等综合治疗。术后5年时发现门静脉血栓,出现肝功能异常,经保肝、抗凝、补充白蛋白等治疗后肝功能逐渐恢复。患者肝移植围手术期及术后接受常规抗乙肝病毒治疗。术后常规服用抗排异药物。结果该患者肝移植手术及术后恢复较为顺利。肝移植术后2次肝癌复发均成功治愈,第2次复发治愈后无肿瘤复发。乙肝病毒脱氧核糖核酸定量均小于103copies/ml,患者至今仍然健康生存,肝功能基本正常。结论对原发性肝癌切除术后肝癌复发的病例,只要复发肝癌符合中国杭州标准,仍应积极进行肝移植。对于肝移植术后新肝复发肝癌的患者,积极的序贯综合治疗及手术切除仍可能获得治愈。

Liver transplantation for recurrence of primary liver carcinoma after resection and therapy of recurrent hepatocellular carcinoma at the liver graft (a long-term surviving case report and related literature review)

Objective Outline the experience of 1 case of liver transplantation for recurrence of primary liver carcinoma after resection and the therapeutic measures for recurrent primary liver carcinoma of the newly transplanted liver.Methods One patient underwent liver transplantation because of recurrence of liver carcinoma after resection in Air force general hospital of Chinese PLA on November 14,2003.The patient accepted venous chemotherapy 3 months later.19 months after liver transplantation,recurrent primary liver carcinoma was found in the transplanted liver,and then the sequential therapy of radiofrequency ablation,hepatic artery chemotherapy and embolization,introperative radiofrequency ablation and tumorectomy were performed respectively.32 months after liver transplantation,recurrent primary liver carcinoma was again found in the transplanted liver,and then the sequential therapy of hepatic artery chemotherapy and embolization,introperative radiofrequency ablation and tumorectomy were performed also respectively.5 years later after liver transplantation,dysfunction of liver emerged due to portal vein thrombus,then the patient underwent hepatoprotection,anticoagulation,supplement of albumin and other treatments,and gradually gained restoration of liver function.Anti-HBV therapy was given to the patient during perioperative and postoperative period.Anti-rejection therapy was also given after liver transplantation.Results Liver grafting and postoperative recovery was successful.Therapeutic effects for twice relapses of primary liver carcinoma in the transplanted liver were satisfactory,and from then on no liver cancer relapse has emerged.The serum HBV DNA level of the patient was always controlled lower than 103 copies/ml.Up to now,the patient is still alive and has normal liver function.Conclusion For the patient with recurrence of primary liver carcinoma after resection,liver transplantation can be undertaken if Hangzhou criteria was met.If the liver graft recurrs hepatocellular carcinoma,active sequential therapy and tumorectomy may attain satisfactory results and prolong the patient′s life span.