原发性肝癌肝切除术后复发患者的肝移植治疗

目的观察肝移植治疗原发性肝癌肝切除术后复发患者的疗效。方法回顾性分析11例原发性肝癌肝切除术后复发接受经典原位肝移植治疗的受者的临床资料，观察移植效果。结果在围手术期，1例术后发生移植肝功能不全和凝血功能障碍并发肾功能衰竭死亡；1例术后出现急性胰腺炎，给予生长抑素治疗10d缓解；2例发生急性排斥反应，行大剂量甲泼尼龙冲击治疗3d逆转。10例受者顺利出院。出院后，3例分别于术后第5个月、第7个月、第19个月死于肝癌复发，1、2年受者存活率分别为72．7％（8／11）和63．6％（7／11），至今最长存活的1例已达4年余。获长期存活的受者肝癌肝切除术前原发病均为小肝癌，肝切除术后复发行肝移植时肝癌均符合Milan标准。结论小肝癌行肝癌肝切除术后应密切随访，如发现肝癌复发且符合Milan标准可考虑行肝移植治疗，患者仍有可能获较长时间生存。

Liver transplantation for recurrence after resection for hepatocellular carcinoma

Objective To observe the effect of liver transplantation for hepatocellular carcinoma （HCC） recurrence after resection. Method The clinical data of 11 patients who underwent orthotopic liver transplantation for HCC recurrence after resection were retrospectively analyzed. Results Perioperatively, 1 patient died of allograft and coagulation dysfunction accompanied by renal failure after liver transplantation; 1 had acute pancreatitis and was cured with a 10-day administration of somatostatin; and 2 received large doses of methylprednisolone to treat acute rejection for 3 days and were cured. The discharge rate was 90.9% （ 10/11 ）. In the follow-up period, another 3 recipients died of HCC recurrence after liver transplantation in 5, 7, and 19 months, respectively. The 1- and 2-year survival rates were 72.7% （8/11） and 63.6% （7/11）, with the longest survival time of more than 4 years. Both the primary disease and recurrence in the 7 patients who had achieved long survival met the Milan Criteria. Conclusion The patients who underwent HCC resection should be carefully followed up and once recurrence is detected, if it meets the Milan Criteria, liver transplantation may be given for potential long survival.