肝脏恶性肿瘤肝移植术后肿瘤复发的临床研究

目的 总结肝脏恶性肿瘤患者行肝移植术后肿瘤复发的临床特点,探讨术后复查的规范方法和治疗复发肿瘤的措施.方法 回顾性分析215例原位肝移植患者的临床资料,分析其中81例复发患者的肿瘤复发时间、复发部位和治疗效果.结果 81例患者的随访时间为6～108个月.首次发现肿瘤复发的时间为肝移植术后3～20个月,常见的复发部位为肺、腹腔种植或淋巴结转移、移植肝内复发和骨转移.复发肿瘤的治疗以局部治疗为主,包括肺转移瘤切除术6例次、伽马刀治疗74例次;腹盆腔转移癌切除术10例次,腹腔淋巴结伽马刀治疗8例次;肝转移癌切除术6例次、消融治疗5例次、伽马刀治疗15例次、TACE 33例次,二次肝移植3例次;骨转移瘤切除术15例、伽马刀治疗16例次以及病理性骨折内固定术3例;脑转移瘤伽马刀治疗4例次.本组患者治愈3例,带瘤生存6例,已存活21～56个月,中位生存时间为39个月.死亡72例,中位生存时间为15个月.结论 肝移植术后对恶性肿瘤患者要进行有针对性的规范检查、积极治疗复发肿瘤,尽量延长患者的生存时间.

Postoperative recurrence of liver malignant tumor after liver transplantation

Objective To study clinical characteristics of postoperative recurrence of liver malignant tumor after liver transplantation,the postoperative standard evaluation,and treatment for recurrent tumor. Methods We retrospectively analyzed the data of 81 recurrent cases among 215 patients undergoing liver transplantation for malignant liver tumors,focusing on the recurrent time and location and the result oftreatment.Results The follow-up time ranged from 6 to 108 months of all the 81 patients after liver transplantation.The time of tumor recurrence ranged from 3 to 20 months after transplantation.and lung,abdominal cavity,new liver and bone were among the most common places of recurrence.Local therapy was the mainstay of therapy,including liver lobectomy in 6 cases and gamma knife treatment for pulmonary metastasis in 74 cases;Resection for abdominal mass Was performed in 10 cases.Gamma knife treatment for abdominal lymph node metastasis in 8 eases,resection of hepatic metastatic tumor in 6 cases,ablation therapy in 5 cases,gamma knife treatment in 15 cases,33 cases underwent repeated TACE and 3 cases received re-transplantation for liver metastasis;For bone metastasis 15 cages underwent resection,16 cases did gamma knife treatment and 3 cases underwent internal fixation for bone fracture caused by bone metastasis;For intracranial metastasis 4 cnses received gamma knife treatment.3 cases were cured,6 cases were still alive with recurrent tumor for 21～56 months respectively and the mean survival time was 39 months;72 cnses died with a mean survival time of 15 months.Conclusion The regular and standard close follow-up for liver transplantation recipients suffering from primary liver malignant tumors and aggressive therapy for the recurrent tumors help prolong patient's survival.